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FOR OFFICE USE; -------- ----- - ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..df-------- .4, (Complete in Duplicate) a/ ------ -------1------------- -------------------------- 116 2,;k ----------------------------- ------------------- This Permit Expires 1 Year From Date Issued Date Issued -----I --------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County'Ordinance No. 549.- JOB ADDRESS AND LOCATION.......6.11-------T--------STREET--------------- - ---------------------- Owner's Name-----W.0,0-DRQ.\.A--1------------ �--�t.BRIUMI=F�7>/------------------------------------------------- Phone-----•..........------ .......... Address-----••. -T........... ---I -r----------------- ----------------------------------------------------- Contractor's Name------------0 W. -N.F-F�-7--------------------- ----------------------------.1,----------------------------- Phone----------------------------------- Installaflon will serve: Residence {Apartment House []-'Commercial [3 Trailer Court [3 Motel ❑ Other 0 rooms Number of baths __-/--- Lot size ...... ---------- ---L�-------------------- Number of living units: ---I---- Number of bed Private M Depth -to Water Table -,f- ft. .0"K, -r.R.0, Water Supply: Public system Ej Community system ell, TF, Hardpan [I Character of soil to a depth of 3 fee+: Sand 91Gravel [] Sandy Loam ga""Clay Loam I-] Clay [j Adobe ❑.Previous Application Made: (If yes,date____________________) No �New Construction: Yes �No E] FHA/V At Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool-permitted if-pubrid-sewer is'available within 200 feet.) Septic 1-ank: Distance from nearest well-N.0fVE-Distrance from foundation--4/0--------- ----------- No. of compartments--------2—----------Size-3.X--'7 Liquid depth--.-----/-----L ------------capacity---gp-O....... Disposal Field: Distance from nearest well-N.6W.E.,Pistpee from foundation.../ ---------Distance to nearest lot Ii ------------- ' I ".V 41 Length o --- Number of lines--------- --------- L f each lineJ�---#--!;--5--.-..Width of trench!!�..:Kg.!----------------- Type of filter material... of.",filter material------/I?- -----Total length__.......1/0 ----------I----------- Seepage Pit. Distance to nearest well----------------------Distbncelfrom founcl�Dtion-------------------Distance to nearest lot line----------------- ;.j I ---------------------Size: Diameter----------------- -----Depth------------------------- ------- El Number of pits----------------------Lining material Cesspool: Distance from nearest well—--------- 'i�fa-nd'a frornJounclafion-------------------Lining material-_»-%-------------------------------- El Size: D6tneter'------------------------------------Upf h ------------------------------------------------Liquid Capacity---------------------------gals. V V Privy- Distance from nearest welance from nearest building------------------------------ l------- --------- ------Dist .................................................................. Distance to nearest ]of line____________________ - ----------------------------- 0 Remodeling and/qy_rrepair ,(describe)--=------------------------4--;--------`- -------------------------------------------------------------------------------------------------........ ....................................------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- ------------------------------------------------- ---------------------------------------------- ,V.-j--------------- - ------------------------------ ----------------------------------------------------------- ---------------------------------------- -------------------------------------------i?-- ------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, at laws, n -ru as and_mgulations of h at Joaquin Local Health District. -- ----- -- -----1.1--------------------------------- .................!---------(Owner and/or Contractor) (Signed)---- ;41 -I a a- By:------------------- ------- ---IWAN.U.- a)------ACT-EPQ--r�------------------ -------- ------- --------I--------friti (Plot plan, showing size of lot, location of system in relation ells,-buildings, etc.,tcan-6ej placed on reverse side). FOR DEPARTMENT-USE CATION ACCEPTED BY . , ONLY- -------------- --------------I------------•---~rI)Ai�---------7=-/7-7-46-27-—-------------- -- APPLI -------------I ....R0 'REVIEWED BY-------------------------------- -------------------------------- ------------------------ -------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------- ----------............"";- ---------------------j------------------------ DXTE-------------------AFterati ns and/or rec-ornrylendations:---------------------------------------------------------------------------- ------- ------------ ----- ------- - ----- Z--------- ---------- - --------- ---- ....4"W- - ;& ----------- ---------- -- ------------------------- ----------------- -------------------------------------------------------- ------------------ -------- ---------------------------------------- ........................ .. -------- ------------------------- -------- ...... ----- ---- --- - ------------------------------------ ------------- ------ --------- ------------------------ -R-0- FINAL INSPECT BY:-.- Date-----------//--7-7 774-Z----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak STr*9t 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISV3 8.59 EM 5-62 ATLAS