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rAJK uac: r APPLICATION FOR SANITATION PERMIT Permit No. .. ................................................... .. (Complete In Duplicate] This Parmit Expires 1 Year From Date issued Date Issued .. .._._.._. Application is hereby made to the San Joaquin Loral Health District for a permit to construct and Install the work herein described. This application is made in compliance with County Ordinance No. 549.n 5-71 JOB ADDRESS AND LOCAT N_L��-^. . ... �f,��..��+ .../.1•��/t'""�1��/��l'�,5� r��. Owner's Name__.-1 1Lar�lllL�a�-f .......... Phone_._.........--.........._-_-....... Address._. ;::.._ 404Q .,_ L'rf. / ....... yG. '`rc/ ��t'...... - Al�'r�. > .�1rr .e ................. -.-............... eft Vic"',? Contractor's Name___...._... ..,�..-:_ ...�:!'� •sn'G../...»��`17�.,,.�¢..,-z,J.S,.,,�..�r'..G.._ _.....___......._....-.___ Phone. ._... .. Installation will serve: Residence Q Apartment ?louse [] Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ... .... Number of bedrooms -.. .... Number of baths ../-- Lot size a Water Supply: Public system fn Community system ❑ Privatek Depth to Water Table ... ._ ft. Character of soil to a depth of 3 feet: Sand 0 Gravel Q Sandy Loam Q Clay Loam Clay Q Adobe[❑ Hardpan❑ Previous Application Marie: (if yes,dote....................i No� New Construction: Yes No Q FHA,/VA-. Yes l0 No Q TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � ' SAlt'c Tank: Distance from nearest well„w�`�.......'Distance from foundation.._., -•-.._......Material-_-_--� ..�.:t'l tz AI- No. of corrmpartrnents__...?- Size.-.. .. .5is�t` ..'_.....Liquid depth-...! ../.. Capacity..._ Disposal Field: Distance from nearest well.. '` ...-.Distance from foundation...../ -..Distance to nearest lot line7,4!........ Number of lines ------- Length of each line.....49.. _ �r.....Width of trench.....�!�.............».... Type of filter material..... .... _C1� ..Depth of filter material..-- ..--_-- --.Total length.._.............___._ _.... Seepage Pit: Distance to nearest well..........._..........Distance ffiorn foundation--------------------Distance to nearest lot line_,.....-.»._».., ❑ Number of pits......................Linino ma#erial..__.._....._...._..Size: Diameter .. ..---..._...._._.__.Dep#h.......»._... Cesspoci- Distance from nearest will._.,»._. ...._Distance from foundation.. .... ....... . Lining material._.....» ji Size: Dia Motor....................... :.. DeN#h_._.. __.__._..__._.........................t i uid Capacity ..»...gals, Privy: Distance from nearest well,.......... .............................. Distance frorn nearest building..._...._..---•_•-•_.._,,.,.............. i] Distance to nearest lot lin©_......_...»...........»»_..-•..............._......_..._._....._.-..........----------••---------..............,..._..._._.._..». Remodeling and/or repairing Idescribo):_--_-____.._............. ........._................................................................ »_..._ ..... ,.......... .»..... ....................:�:.........___..._»»......._.�._.»_...__•_......_ . ».' ......»_.»»...... ..__.......__». ._»..._...__.__............�._............. __ _ .. I hereby certify that I have preapplication and that the work will be done in accordance with San Joaquin �nfy ordinances tete la and rules regul ns of the San Joaq ', Local Health District. _ (Signed)-•------ . .L�•--•.... ......... :y :. - .: - ..,.. {C3vrner and/or Contractor]By:.....-------------•--. .............{Title).. .�r.- . ... (Plot plan, showing size of lot, location of syst m relation to wells, buil etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.....,f' -. . ... ...... ....... ..__.. ............____............ ...».._...._. DATE. j r r. .. .!-.....__...................... REVIEWEDBY.......,.._. ........ __,_...................... ... _...».... ._ ...,».,....»........ . _._ DATE...._.._.........._.._...---•••..».. ...... --._.. I. BUILDING PERMIT ISS DED........ _...__..._._....._.»»_ DATE................_........ .._.....�_._._.,..__ __... Alterationsand/or recommendations:-.............. ................... .__..__,._ ...»..._ ...........«,,..M,...».....»....................» FINAL INSPECTION BY:. _......... .... Date..... ._. . `e e'..............................__. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 900 Well Oak$erect 134 Sycamom Street 205 W410 901191110011 3+ockion,California Lodi,California Manteca,Callfornla Tracy,California ES 9 REVISED 5-59 am 5161 ATLAS