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FOR OFFI E US . ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. ___..:...g............ .- —----------- -- �G� -- (Complete in Duplicate) Date Issued ...... l ........... r2, --------- ------------ --------------------------------- .___ This Permit Expires 1 Year From Date Issued .. 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. JOBADDRESS ANN—D LOCATION............ ------------ tl...----------------------------------- -•------------------------------------------------- Owner's Name._.__1lslrG�rtlj!%LG Phone_______________ Address- -----------•------------------------------------------------------•------------------•-_.------------------•-------------- Contractor's Name .____1�� _._ :s--------------- _-- Phone ................. --------------------------------------------------------------------------------- ........... ------- Installation will serve: Residence f Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:. -___ Number of bedrooms_-�Nf bl .. umber of _______ Lot size___oro_X17114�............................ � f r Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Ilf yes, date____________________) No 4T"' New Construction: Yes 11 No ❑ FHA/VA: Yes ❑ No Ry' -- TYPE TYPE 01= INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feeg Septic Tank: Distance from nearest well - _—----- Distance from foundation_/q_____________ Material ------- ......................................... No. of compartments -._:2 —---------------- Size -------- 3Y,5"X__9 ----- Liquid depth -------- 9.__ ----------- Capacity ... rrF.F�_C4 Disposal Field: Distance from nearest well ------.... Distance from foundation ... 10..__........Distance to nearest lot line..........JI. Number of €ines________________________________ Length of each line ---- .------- 1� Width of french ------------ -------------------- Type of filter material.-'.W_#e_t------- Depth of filter material ------ j$_'______._Total length ................ IPA.....___.........__ Seepage,p�t: Distance to nearest well___:—_ ---------- Distance from foundation__- 0,_...._.___ Distance to nearest lot line__4-/____._ [� Number of pits___:'j---------------- Lining material__ 4" ---.Size: Diameter_____ . -_._..._.:Depth ---------- jpl.5'----------- Cesspool: Distance from nearest well -------------- _Distance from foundation ------------------- Lining material .............. .____-----..__._:______ ❑ Size: Diameter -------------------------------------- Depth ------------------------------------------------- =--Liquid Capacity -------------------------...gals. Privy: Distance from nearest well ------------------------------ _------------------ Distance,,,from nearest building ___.-...-.._._.-.._..___-_-______..____._. C] Distance to nearest lot line ----------------------------------------------- --- ------ ............. ---•--------------------------...-----------------------------•------- Remodeling and/or repairing (describe):----------------------------- ------------------------------------------------------------------------------------------------------..__..-----_------ -------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 egul tions of the San Joaquin Local Health District. (Signed) ................................ .•-• ---•• -- ---. --- -----.......... ---------------------------------------------------------------------------- (Owner and/or Contractor] By------------------_-_----.-. ........................ -------------------------------------------------------------------(Title)------------------------------- ..._....----------------- (Piot plain. showing size of lot, location of system in relation to walls, buildings, etc., can be placed on reverse side). R ONLY APPLICATION ACCEPTED B ----- ---------- DATE -•-----�-'--�--�'-�-�.�•---•---------- REVIEWEDBY -_------------_----------- -------------------------------------------------------------------------------------- DATE ----------------------------------------------------- BUILDING PERMIT '. ISSUED -- •-- -D4� TE - 1 - C + ---------------------------. Alferat'ons and/or recomm ndations:--/"'-1?-__�� -- �----- �:...1<---------------------------------------------------- ------------ ----------------------------------------------------------------------------- -------------- ------ ............................................. ---------------------------------------------------------------------------------------------------------------------------------------------------- .._....._. FINAL INSPECTION BY:...... Date '� z� _---.--------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9th Street Stockton, Callfornla Lodir California Manteca, California Tracy, California ES 9 REVISED B-59 ZM 5-61 ATLAS