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FOR OFFICE USE: F ---.------------------------------ U'OAPPLICATION FOR SANITATION PERMIT Permit No. ----- -------=------ ------------- -- - ---------------- ,6.7,( -------------------------- ----------------- (Complete in Duplicate) VC,This Permit Expires 1 Year From Date Issued Date Issued ......_.:_ Application is hereby made to the San Joaquin Local Health District for a permit to can uct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 3, �v �,. � q�_"_" G� r � G JOB ADDRESS D LOCATION I -. ............. • ------......I....... . ....... ......... f `h h �� OwnersName--- - - - -..�.--_T�!1 -•-- - ----••-�------------••-------------- ••-�••-----.. Phone.................................... Address = ®Q-•-•- . `��''J- 1 "'..tee..----- -.--- ---••----•-------------------------------------- Contractor's Name.. o f es' " o --------------------------_--- Phone----------------------------------- Installation will serve: Residence A artmen�t House Commercial ❑ Trail r Court ❑ Motel ❑ Other ❑ Number of living units: ___.____ Number of bedrooms t;?__,Number of baths ........ Lot size .. d.__...X_rr __,70 ................. Water Supply: Public system ❑ Community system ❑ Private iX Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam P( Clay Loam ❑ Clay ❑ A ❑ Hardpan ❑ Previous Application Made: {1f yes,date___._______________1 No ® New Construction: Yes E No ❑ FH es$ No [3 Q TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) SBptip T Distance from nearest well._____ __ ..Distanc��from�foundation____-.� ___ ___.Material............. . .... ........ ............... No. of compartments------ _Size_O b[1�____9_V__P Liquid de .th______#.`-------------Capacity f o, i ,-t- Disposal Field: Distance from nearest well---__Z_?_4_......Distance from foundation----60...........Distance to nearest lot line----I..._._.. � Number of lines--------------1.-_----- -- --� Length of each line______ .-.�.-_.----------Width of trench..... ....... . ................... Type of filter material...�l•"-�v_C�fz.------Depth of filter material-------I ..._......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--------------------------------- �w Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material---___-_---______________ __ ❑ Size: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity gals. a rA Privy: Distance from nearest -------- -_ - well----------------------------------------- _._Distance from nearest building............................ w 0 Distance to nearest lot line---------------------------------------------------------- �' Remo Bing And/or //}yep iring J(de�scribe):--------�91/_ - +Qre.-�Q-- --- /`- a/,f/-/�y---- _-74-(4/-/-_-----. ... - ----------------------------------------------•--_________ --------_••--------•-------._...._•______•_______________•_______-__••__•_•_--___....___••____ __________________________________________________ _ ,Iy�' _______________________________________________ _________________________________________________________________________________________________________________________________________________________________________ y 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 r s and regulations of the Sa Joaquin Local Health District. ,a 4 d I (Signed)--...- ------ - ... - •--------- ------- ----- ------------------- (Owner and/or Contractor) By:--------- ------- - - -•--- • -•-- ------ - ------------------------------------ -_---...-------{T'itle)---------------------------------------- (Plot ---------------------------._ ------ _.. . � a (Plot plan, showing size of lot, location of system in lation to wells, buildings, etc., can be placed on reverse side). . FOR DEPARTMENT USE ONLY .. nr +•s APPLICATION ACCEPTED BY__, - ____ ---____.___ R DATE----- `' r. REVIEWEDBY-------------------------------------------------------------------------------------------------- ----•-•--_.... DATE-------• -------•-------------- rr BUILDINGPERMIT ISSUED----................. ------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:-------------- ----- ------------------------------------------------------•---•------------••-------•--------------------•-••---------- ................. m ............ .----------------------------------------------------------------------------------------- -------------------------------------------------------.......................................................•---•-- ro -------------------•-------•••-------•-------------•-------------------------------•-------•------------------•--•--••--------------------------••------------------------••••-- ---•••-•------------------------------------ ---------------•---------------------------------------•------------•-•-- ------------------------------------------------------------------------------•-------------------------------•---•-------------------------------- C FINAL INSPECTION BY-_- - ..-_ _ _ _e_5,_._ ~-.--..- �r 0. p. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Sheet 205 West 9th Strout Stockton,California lodir California Manteca,California Tracy,California ES 9 REVISED 6.59 1M 5-61 ATLAS