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vrrI%, LF0c Y ----- / ---- APPLICATION FOR SANITATION PERMIT Permit No. ... --------------I----------------------------- (Complete in Duplicafe) -----------------F -------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby mad o 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.....;V I 4? ,-_. - 0 --------------------------------------------------------------- -............... Owner's Name +.P.� -------- Phone..................___-----•---- Address._--•.......... 1Q J Contractor's Name � -------- fes!/ - ----------------------I•-•-----f...................... ............................ Phone................__.......------.. Installation will serve: Residence l?Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _J._-_ Number of bedrooms --- Number lof baths _/_-- Lot size ............................... Water Supply: Public system Community system ❑ Private ❑ 'Depth to Water Table AO ft. Character of soil to a depth of 3 feet: Sand ❑. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_------------------) No U?'O' New Construction; Yes ajo"No ❑ FHA/VA: YesZ?""No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic Tank: Distance from nearest well_____--------Distance from .- foundation_---10...._--.mater e N Y0------- Liquid depthNo, of compartments------- Capacity . Disposal Field: Distance from nearest well---'.`.�--_ Distance from foundation...169--._....Distance to nearest lot Iine.4.1__.... Number of -' / Length of each line____60:9__Q ------------Width of french..t2 Type of filter material/lel .-Depth of filter material•.-- ....Total length----.r-.��----------............. Seepage Pit: Distance to nearest well----------------------Distance from fou' ndation..............------Distance to nearest lot line-----------._.... ❑ Number of pits----------------------Lining-materia[.--- Diameter_.-,__._`---_1.-_.Depth-----------------_-------------• p� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material......................__-----.-.__--_ �U ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity-------------------- gals. Privy: Distance from nearest well-------------------------------------------�'Disfance from nearest building.-_------_._-.-..___--.-_-_---.--.-----.-. ❑ Distance to nearest lot line---------------------------------------- ------.................----------------------------------------- ••--------••----------- Remodeling and/or repairing (describe)-----------------lbn/ _'_ -••-----------•---•------------••---- •----•---•-•-•--- i / ••-•---- .......................... ----------`--•-•------------•----------------- -- ..----------•--------------------- -------------------------------------------------------•--_-----------------------------------------------------------.---------------------------.----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) - ••--- --------------------------------- - ------------------------------�r Contractor) BY: ----t--- �affin ` 1 {Title)------ 6u L�1u,��--•---......... (Plot plan, showing size of lot, location of system in wel!s, buildings, etc., can be placed on reverse side). JFOR DEPARTMENT USE ONLY_ APPLICATION ACCEPTED BY------ �...... r-7t4i;t--- ----------------- ------------•-------•-•---------------- DATE....3 Z REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED---------------------------------------------------------------_-----:---------- - --- ----- DATE. Alterations and/or recommendations:----�.--L-(a-'----(�- [- `-----•i•� -nno -f�']vi y_ -�------ , ---------------------•----------- FINAL INSPECTION BY:----------TeVA- - Date--------•------------ SAN JOAQUIN LOCAL HEALTH DISTRICT t. 130 South American Strout 300 West Oak$Treat ` 'i 24 Sycamore Street �' 205 West 9th Strout Stockton,California Lodi,California tMantecaCalifornia f " Tracy,California E6 9 REVISED e•59 2M 8-61 ATLAS