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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .�1��1.� -------- --------------------- -------------------------- 1' (Complete in Duplicate) ------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued O`� t 'Z2-0--07 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. J08 ADDRESS AND , ----------------- G _. ------ Owner's �ATION --------•-- - - Owners Name------ -- -•--- A�< °e.----------N ------------- ---------- --------•------- - Phone...........------------------------ Address................................ - Contractor's Name..-- _..------ ------ •---------------•r-}-= -----------.................. :Phone................................. Installation will serve: Residence part ent House ❑ Commercial'[] Trailer Court [] Motel ❑ Other ❑ ( l� at r r. � i ' 1 Number of living units: ._... Number o bedrooms-.3_• Number of b t! _____. Lot size _.__. �_ i N _. Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table f,7_ ft. Fx 3 / .F Character of soil to a depth of 3 feet: Sand Ej Gravel ❑ Sandy Loam ❑)l Clay Loam ❑ Clay ❑ Adobe Hardpan E] Previous Application Made: (If yes,date._______# ------) No FNew Construction: Yes o F❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,or cesspool permitted if public sewer is available within '200 feet.) - f e Septic Tank: Distance from nearest weltr?_---------Distance from foundation_/tl-----------Material�w .................. ______ --t No. of com artments__ f --, '�" ___,1`_Li Liquid de th_______________________--Capacity. p Size q PA----------------- Disposal Field: Distance from nearest well,-----------------Distance-fr f$ i n.- ..0----------Distance.to nearest lot line---�_f---_• 0/ Number of lines------J�, -IV--5 _'!&ngth of lin ~ -_ !-------- �--< <� .___- Width of trench____ -�, _______._ Type of filter material._._ �y___r�S: Depth of filter material___/1.-___-______Total length______/.0__ _____________________j Seepage P' Distance to nearest well.... ----------------Distance from foundation---,lQ_____----.Dista a to nearest lot line________.___ Ek Number of pits____--__-Zc__I__Lining material7rt�t __-_-"Size: biometer., _�u-'�,.__ Depth___ra , ..................... Cesspool: Distance from nearest well-----------------Distance from foundation---------------.----Lining material.---._____-__________•----_-______-_ ❑ Size: Diameter--------------------;--------------..Depth------------------------- -----------------------Liquid Capacity--------------------........gals. Privy: Distance from nearest well___________________________.-_-- Dis nce from nearest building_____--..--_______________.____._______._. ❑ Distance to nearest lot linb-------------------------------------------------- ................... ..... oe Remodeling and/or repairing (describe}:------- dJ--- J- ------...---•---•-•••-•--•-•-------•----------------------------- ----------------------------------•.-------•---.- ---..--------------------•-.---------------------------------------....---------------_----------------------------------------------------------------------- 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 laws, a rules a re uiations of the San Joaquin Local Health District. (Si ned 9 )-------------------• - -vf�--- --••---- --- --- - - -�--�--- ------------------------------------------------------------------- -------(Owner and/or Contractor) , r By: `- ---------- - i F -------------------- (Plot plan, showing size of location of system in re #' n to wells, buildings, etc., can be placed on reverse side). F R PARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------- ------ ----------------•-----------------.---- DATE � � Ga REVIEWEDBY------------------------------------------- -• ---------------- --------------------•--------------------------------------•- DATE-------------------------------------------- BUILDINGPERMIT ISSUED--------------------• ----------- ... -----------------------—------------•-----------------------.- DATE---------------------------------------:.. AIF ratios and/or recommendations_____________________ a 77".7_� .�_ _.__._..._ _.._ _' ---••- ------- --- ---- ----• ------------- ••-----------•--------------------••----------•------ - ------------------ ------------------------------------------------------------------------------------- -- FINAL INSPECTION BY------ ................... - - -7T `° �'� Date { SAN JOAQUIN�LOCAL HEALTH DISTRICTf� 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 5-59 2M 5-62 ATLAS