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rvR uJc; ----------•--------------------------------------------- X _/�,._ APPLICATION FOR SANITATION PERMIT Permit No. ..?..5..ZP ---i� (Complete in Duplicate) ------ This Permit Ex ires 1 Year From Date Issued Date Issued _•-__._-.---.--_ G 1— 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 Coun Ordinance No. 549. Rd JOB ADDRESS AND LOCATION--- .�.--�----- --��...�t�o� c�'�. _"�x�..1------------------ ..-------...--- ....----------•------------- Owner's Name ---------- -------•---•-----•--------------------------------------------- Phone.,Tl ...JL 417 Address---- 2214 ':�- Phone- 6Contractor's Name / Installation will serve: Residence �parfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _____ Number of bedrooms%.,"3--- Number of baths /-___ Lot size _��j�� ..'.................•.. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ee) ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe Hardpan ❑ Previous Application Made: (If yes,date____________________) No E] New Construction: Yes [-INo FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1�� 1� No. of compartments Size Liquid depth y-:: Se tic,T kk Distance from nearest well_______________•Distance from foundation_______......_..___.Material------- Capacity....................... Disposal Fled: Distance from-nearest well-________________Distance from foundation....................Distance to nearest lot line........_........ Number of lines-----------------------------------Length,,of each line....._______-__________--_-._-Width of trench____--.-•-•_-___-_______- Type of filter material_________________________Depth'of ifilter material__-_._________________Total length_--`�_______.__......._._________--_--• 14... � -. Seepage Pit: Distance to nearest well-1-Ip0_ __.___Distance from oundation_.10---..___.Distance to nearest Number of pits____________________Lining material-RLtC- -----Size: Diameter- DistanceI Cesspool: fiom nearest well_________________Distance from foundafiion___-______-___-_-__.Lining materia._____.____.__________--••-_-__•__❑ Size: Diameter--------------------------------------Depth---i-----------------------•------------------------Liquie['Capacity--------------------........gaPrivy: Distance from nearest well-_________________i— -_____-____ -.-Distance from nearest.building._-____._______-_---____-_•__❑ Distance to nearest lot line-------------- tRemodeling and/or repairing (describe):----•------------- ---..-......--..------_ _ �. ��. ----•-------•-•--------.•--••---•--......__..•----- --------------- - c� � � a 1 ------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawri, and rules and r gale io of the San Joa Local Health District. �� (Signed!. -r L ... ]�--- _�' _ _.�_ .---------•-- Contractor) By:......----------------------------------------------------------------------------- 5.. _ _✓- - ---- ----------(Title)-------------.--------------------------- (Plot plan. showing size of lot,-location of system in relatlo� wells, building fc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B _-_-- ____-- ------------------ ------ DATE..___-.. .-- -----.(.-- REVIEWEDBY------------- -••---------------------------------------•------•---------------------------------------------- DATE---------------- BUILDING PERMIT ISSUED- ••• -----------------------------•---- ------:------------------....-. DATE. Alterations and/or recommendations:__ _, __ ............. -------------------------•----------------------------------------------------- --------------- -----------------------------------------I----- - -•-•---•-----------------•-----------------• - •------------------•--- -------------------------------•----------•----------------•------.---- :l ° FINAL INSPECTION BY:------ �� i - - -. Ce - .�.-,r..�- ---------- - - �a..�. „ � Date--------- - ----�'�,,,,.,,,....-----------•---•---•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9 9 REVISED S-59 2M 6-61 ATLAS