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FOR OFFICE USE: ..............._.__.__._---..____..__._..___----_-.--- 3 PPLICATION FOR SANITATION PERMIT Permit No. ..1_3•_1�_Za ----------------------------------------------- ----•---- (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued Date Issued _............ L._..� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe . ,This application.is made in compliance with County Ordinance No. 549. ass[?_6 � O JOB ADDRESSAND LOCATION_ -•-- - or Q I 1� ) 1j �7 Owner's Name----------•-- 1.+ L - � c �� Phone y� ( 7.5� Address----- _ xt�l 16S' .......... ----------•--...------•-------------------••--------------- Contractor's Name....... - -- Phone. .... --- ---------------------------•-----•-•-------- -•-••-••- Installation will serve: Residence tj-__Aparfinent House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ S 2oO Number of living units: ..__. Number of bedrooms. _____ Number of baths Lot size _._,�i�-________ __________________............... Water Supply: Public system ❑ Community system ❑ Private &-16,pth to Water Table _�,x_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay LoamClay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (1f yes,date--------------------) No New Construction: Yes <o ❑ FHANA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sower is available within 200 feet.) RECO�-�`� ,,/ . Septic nk: Distance from nearest well.___ _�_-...Distant fro foundation....fa_._..__.Material___00w-C�o- �w 1 .......................• No. of compartments_-____ ..____Size__/ _ __ --~ Liquid dell+h____ -._----------Capacity... _ Dispose geld: Distance from nearest well.-.50 Distance from foundation..4a..........Distance to nearest lot I'ne._._ ........ Number of lines_________ __________..---._______Length of each line_... _ Q Width of trench._ ...........___........ Type of filter materlal.•.i9C1C _____Depth of filter material-____f '.._-_..-_Total length.____. ✓ ________________________ Seepage•Pit: Distance to nearest well------ Distancerom ffoundation___-J�_�_. Distance earest lot li -1-------------- m f Nuder of pits________ _ ------------Lining material-_-- S Size: Diamefer_t.r? f -y---_ { Depth_________I................. Cesspool: mss Ir, Distance from nearest well-----------------Distance from foundation--------------------Lining material..................................... El +! `size: Diameter------------I-------------------------Depth---------------•------------------------------------Liquid C.pacify.__.....---------•--------..gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line_-________________ E Remodeling and/or repairing (describe):________- S.±t.E�cz C1 0!7n. -.-D----FoK....Jnt5peL 1 L?-N C-Q-U1 .1V---L4-f:E__-- ------WAS._- FQ..Si-0- -----A73. .0_1------P=- 8 M.t:77S-' +5/6.7;ff� y 1pol'S6.....PIA,._..`7t - F_Qin-------- 0-'---Ff�0m-----'-vjt.i -----t6 K.._1.;....tl_q�1_r__-t _ 19LH- 1S hereby certify tha+,l have prepared this application and that the work will be done in accordance with.San Joaquin County 6 F ordinances, St laws,Awnddles �d regulations of the San Joaquin Local Health District. I (Signed)..-_ter- -- - ---------------------------------------------------------------------- ------------(Owner and/or Contractor) By:.......... ........ , ��-�---- -------------------------------------------------------------------------------••---•---{Tile) ------•----------------------------------------- -------- (Plot plan, she' Ing size of lot, Iota Ion of system in relation to wells, buildings, etc., can be placed on reverse side). s 1< s 1) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---------------------------------------------------------------- DATE------ ---' "..-------------- ==-REVIEWED BY----------------------------------------------------------------------- - DATE = ••----------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------— -----••-----•-••------•--- DATE.----- -------- ----- k I>ik ---------------------- Alterations and/or L57 rrecommend'ations ----- -------------------------------------------------•---------)--••-... __..-----ki- -----0�...AQAC-H----_14'....at_Y.2.---.._ s1.%_...1NFo rti D sG s ...0E- ....ca ��__ D----- ._5 �4'....... �-E 11 .7FINAL INSPECTIO .. .-- ---- Date------ r- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Sweet 134 Sycamore Strut : 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California SO-0 REVISED 0451 !rd 5-61 ATLAS