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FOR OFFICE USE: --- ----------------------------------------------------- ____________________._______.._________---_.-.---------- APPLICATION FOR SANITATION PERMIT Permit No. - ---------------------------------------------------- (Complete in Duplicate) d / 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 constr d install the work herein described. This application is made in compliance with County Ordinance No. 549.,13,/ 0--Z- JOB ADDRESS AND LOCATION------- --�- -.. -� .........� ____- _. ----- Owner's Name Ar- ------------------- . ey_" ...�..------•------•------ oe..._. ll Address___ 213.. !...•rL^^J1? b-c_ ..... .to— f e L • ---------------------------- •---•--- Contractor's Name----- l! -_.T___ e . G_ /--- t ` Pllone--_��.�.�_�_�_^ :�-�S�r/�'� "v7 Installation will serve: Residence[ Apartment House ❑ Commercial ❑ Trailer Court ole Other ❑ Number of living units: ... Number of bedrooms __-(--__ Number of baths __X_ Lot size ..../_ __2---..�___________________________ Water Supply: Public system ❑ Community system ❑ `'Private, Depth To Water Table 1.q. ft. Character of soil to a depth of 3 feet: Sand� Gravel I-] Sandy Loam ❑ Clay Loam ❑ Cay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No 4 New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ _ _ TYPE OF INSTALLATION AND SPECIFICATIONS: „ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---6._G___._Dista ce from foundation_.!�G._ __..Ma erial_ ��r` --P_�___�---- No. of compartments..-_____ -_____________Size �w !)`. ..Liquid depth___ . _____Capaci ®a Disposal Field. Distance from nearest well.-70..-.._..-Distance from foundation-_ S________._.Distance to nearest lot line./. ..... .O Number of lines----------/.... _-__.____Length of each line_____ © Width of trench____Y _� Type of filter material._.. _/�! '.__Depth of filter material_____ ___ _.Total length----�.f. r.��---____ Seepage Pit: Distance to nearest well . _____________Distance from foundation....................Distance to nearest lot line----------------- �1 ❑ Number of pits------------- Lining material-----------------------Size: Diameter-----------------------Depth................................. Cesspool: ,.�&,sfance from nearest wer_.1 _ Distance from foundation-.--_--_____________Lining material..--.._____________._________________Size: Diameter------------- --- -- - Depth--------------------------------------1i------------Liquid Capacity---------------------------gals . Privy: Distance from nearest well_____ ______ ________________________- -- from nearest building------------------------------------------ ClDistance 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 regulations of the San Joaquin Local Health District. (Signed) 6 `-Jf- `-C ----------------------------- -----------(Owner and/or Contractor) By:----- -- -----------------{Title) (Plot plan, showing size of lot, location of syster in relation to wells, buildings, etc., can be plat d on rev rse stile}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----fit� �___5cd f__ _U..� 09,S'- ---_ji,�----- BATE__ �1 ` j` _________________________ REVIEWEDBY------------------------------ --------------------------------------------------------------------------- DATE------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------------.............. Alterations and/or recommendations:-•-•---------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ------ -----------4 V- .----�Z- ....--"` .-' - 1N .L.�r.. -f S ��'T •• . F O t ____ �.Oity, � k M>iQU L?..._.. N1=-,lr ,l Q -- ------------------------------ FINAL INS ION B • .. ._ 1 -- - -- ---- Dafie__..__..___ .r _.... S 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 REVISER a-99 2M 5-62 ATLAS t ,