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FOR OFFICE USE: A _ _.____.._..__. __..____----- APPLICATION FOR SANITATION PERMIT Permit No. .l....... ...l;__?- -------------------------- ------- (Complete in Duplicate) Date Issued ___ ------------------ .......... - - ------------.---.---- 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.. 1 JOB ADDRESS AND LOCATION____.__•_---_•-- - - ..__..T0.5_.�°_ __!_!_..........A_VL __------ I G-- t�----e C ------------ Owner's Name -))-`---- ��'-'-'-`•->!'�4_. ........ x----� i` 'r---5-------------•---------------•------ Phone------------------------------------ Address....................... - Contractor's Name-------------------- f '-•------•------------------------- ------------------------------------------------------------ Phone................................... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motef``❑ Other ❑ Number of living units: ___1____ Number of bedrooms ---J--- Number of baths __!_____ Lot size .........�1 Qer� ......................... Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table ._67 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 .-1 _12_} No ❑ New Construction: Yes �o ❑ FHA/VA: Yes ❑ No 2--- TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspoolpermitted-if puttkicsewer is available within 200 feet. Septic nk: Distance from nearest well_____�d_._Distance ffom foundaPon---10------------Mater l______��!...----------------------------- No. of compartments________-�L______..._ Size....-3__X__R_, ._.Liquid de th__. .?Y�___._ _Capacity gBfl_ Dispose Field: Distance from nearest welL___9©____Distance from foundation....10-.(___-.__-Distance to nearest lot line._. `�.......� Number of lines______________ _------_________ ___Length of each line_._.-�l _ Width of trench...-._ ______________ 3�_ .v_, -r...__..._ Type of filter material.S_e�!,b_ . ___Depth of filter material__-_. _ _ �:'_Total length------------ -{ ------*..0 , Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line................. ❑ Number of pits----------------------Lining material--_-----••---.-----.--.Size: Diameter-----------------------Depth-------..-.---_................. Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material------------..............____.__-_•_ ❑ Size: Diameter----------------------- --------------Depth---------------- •--•- ------------------Liquid Capacity---------------------------- Privy: Distance from nearest well=_-_:-_ _ ____________________a_-_ . ___._Distance from nearest building-----------------.-..___.________________- r ❑ Distance to nearest lot line------------ -------------------- Remodeling and/�o pJrep firing (describe):-- --- f__---� -------------- _____/ J_ _1 6_ --------------- �^ ---- ------- - -- �"'" ------------------------------------- -------------------------------------------------------------------------------------------------------------------- ---------------- --------------------•-------- -•----••----•--•--••----------• -----------------------------------...--•• ----•--••----------•-----•-----------------------•----------------------------.----- I hereby certify that I have prepared this applicafion'and that the work will be done in accordance with San Joaquin County ordinances, Steffe laws,�nd rules and regulations of the San Joaquin Local Health District. (Signed)---------\K_Af�'t--J..... ------•- - - ------ � 1 �=-----------------------------------------------------{Owner and/or Contractorl By: Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------------------------------------------- --- -•-r'Jl t!DATE------ REVIEWED BY---------------------- ----------------------- ----------------- --•-------- ------------- DATE---------•-•---------------- -------------------- BUILDING PERMIT ISSUED-----------------------------------------------------------------_-------------------------------- DATE-- --------------------------------------------------- --------- Alterations and/or recommend'ations:.------.60TH_----- .------- I-[ -------- IA!r ,-•----------- --------------------------------------------------------------------------------•--------------------------------------------------.--------- ------------ ----------------------------------------- -- ------------- -----------------------... -------------------------------------------------------------------------- .......................4 K. ----------------------- FINAL iNSP_ ..._ L�� 1 ---- •--- - Date----- �-�d- --( ------------- 61 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 ES 9 REVISED B-59 2M 5-62 ATLAS