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VUR OFFICE USE: �+�' ------ - --------- -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) --- This Permit Expires ] Year From Date Issued Date Issued �. _..:6_ ' 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. 4 JOB ADDRESS AND LOCATION_____________ Q Owner's Name......_•-- _j_,-•„_ --- ------ ----------------- - •------- Phone..WC, .I Address = - ---- -- ----a---- Contractor's Name----------------- ---- �------ J ----••- --------•---....... Phone.................. Installation will serve: Residence ❑®'j Apartment House CEl •--•--'�'•••'-'-- Commercial Trailer Court [] Motel [] Other ❑ Number of living units: `e.L. 1umber of bedrooms .--.7-- -Number of baths ---/.. Lot size _.. I 31 _ ----•- Water 5uPPIY Public system 14�tommunity system ❑Private ❑ Depth To Water Table Z_J• ft. NN Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑� Sandy,Loam ❑ Clay Loam [5—'Clay E] Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date----..___-__ -----) No �Ne11�fonstruction: Yes ❑ No G---FHA/VA: Yes ❑ No.8.1, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool per if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__-_- ------------Distance from foundafion__�� ---- ---Material____- ----------------------------- -_ -•--------------••----•--- No. of compartments------ --`z-�-----Size---�'X�3xs? Liquid depth-------- - Disposal Field: Distance from nearest well----- -Distance from foundation--- ----Capacity...___._. �? ____S�____.Distance to nearest lot line------:'7!1 Number of fines_______________ /-----------------Length"of each line-------------lro'_-------Width of french...__...___.."�—: T e of filter material-_- � „ -----•--- yp --->�.___DEpth of filter mat I Total length d Seepage Pit: Distance to nearest well------.—r----Distance from foundation.-_t- ___.Distance to nearest lot line_____"�c-_ 0 Number of pits.__..__/.-________Lining ma vial_ _Size: Diameter_--._. ----------.,Depth Depth------x----`�----------•----- Cesspool: Distance from nearest well___ __Distance from foundation--------------------Lining material-------.____________- Size: Diameter-------------------------------------I Depth----------------------------------------------------Liquid Capacity-- ------------------------gals. Privy: Distance from nearest well__________________ _ ---------------------_-.__._Distance from nearest buildin Distance to nearest lot line______________ -------------------------------------------- g Remodeling pd/or repairing (describe): r ` = ei �- -e - .... �..., :'�-----------•------- - ---------- -------------- ------------ --• -------- -- ••-------------- --------- ereby cer#ify that I have prepared this plication a that the work will be done in accordance with Sen Joaquin County ordinance$, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)... c ` .(Owner and/or Contractor) - BY� --- {Title)------------------ Plot Ian, she - ---------�--- -�--�----------- -- p g size of lo#, location of system in relation to wells buildings, etc., can be placed on reverse side). R.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____________ _ p_ T`----------------------------- --------• ----- DATEREV �� - - IEWED BY. --- ----- DATE -----------•-------............................... BUILDING PERMIT ISSUED________ -----•----- �-T E AlFeratio and o recom nda#ions:.___ •---• `---- ------------------------ g � . --- - ------ --------- "7 ----------- - --------- FINAL I SPECT N BY-------------------- I Date . ----•---......-•------ -------x--•-----------------•-- /] USAN JOAQUIN LOCAL HEALTH DISTRICT 1 0 So th Arfr�rican Sheet .•r� a te, 7L,� , y re InJJ 4 �Zd Sycamo205 West 91h Street �tifornia Manteca,California O �`" ornia ES 9 REVISED 8-59 2M5-52 ATLAS Tracy,Cal' � 'p