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FOR OFFICE USE: 3 C ° f L �{_•_____ APPLICATION FOR SANITATION PERMIT Permit No. .......... -------------------------- (Complete in Duplicate)--------------- -------- lDate issued _....`�... � ----- This Permit Expires 1 Year From Date Issued Application 's here made to th San J a n LBcaI Health District for a permit to construct and install the work herein described. This applicatio 's in core Ordinance No. 549. �L ATV LOCA/TI/O(N - i ------��----- JOB ADDRE 1 Q � 4/` ----•------•----------------------- ----------------------•-----------------•- Phone----••....-------------------------- Owner's Name..-•---- ------- --I'�-k�!IaQ...----•----•------------------- Address------- par-- .--------------------------------------•---------------------...----------------•------------------------•-------------- Contractor's Name.-'"' v�,_ TS ------------•--------------- Phone..--------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---(---- Number of bedrooms 3---. Number of baths - Lot size ---------------.YL-x.-f _`�----------------- Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table .fid-- 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 No Q--l"New Construction: Yes [B"No ❑ FHA/VA: Yes I" No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest welk!�.r----._Distance from foundation62-f--__.------.Material------1----------------------------------------- No. of compartments.....n ---------- ------------Liquid depth--l-----------------------capacity...12Ak Disposal Field: Distance from nearest well---4370------Distance from foundation.lb_............Distance to nearest lot line----------------- ♦ .1� Number of lines-------t� Z6---------------------of each line---- of trench..- - ,f!..._.---------..----_-- Type of filter material•-'10-C-k--------Depth of filter material--I-W:..............Total length...45-0---------------------r-------- r Seepagg•Pit: Distance to nearest well.400..............Distance from foundation/A-----.-----_.Distance to nearest lot line_-.f-.>------------ Number of pits_---- -------____Lining material-. +o CE --_Size: Diameter-_- -------------Depth--...."— .-•-_--•_•__•• ,J Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------.----------_--a l ElSize: Diameter--------------------------------------Depth--------------------------------------------------.Liquid Capacity..-------..------------ •-9als. Privy: Distance from nearest well----------------------------------------- --.----Distance from nearest building---..---_-------..-..-----___--.---------- f] Distance.to nearest lot line------------------------ -----------------------•-------------------------•--•----------••----------------•-•----------•-•----------•--------- Remodeling and/or repairing (describe):--- -.-------------- -----------------------•------------•--------------------------------•------------------------------•-•--------•--------•------ -•----•----•••------------------------------------------------------------•-------------•------------------------------------------------------------------------------•-------------•----•---•- ---------•------------ .-•-----------•----•----------•----------------------------------•------------------------•----------•---------•-•-------------------------------•------------------------------------------------------------------------- ----------------------•----------------•--•---•---------------•-----------•---- ---•----------•------------------------------•---------------------....--------------------------------•----------•---------- I hereby certify that 1 have pr p ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules egulati ns of the San Joaquin Local Health District, (Signed) - - -------- ---- ----------------------------------------------------------------•-------------------------------(Owner and/or Contractor) BY:-------------------------- - -,---------------------------------------------------------------------(Title)------------•-- --- ------------------------- -------..--------- (Plot plan, showing size of lot, location of sys:em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- DATI= REVIEWEDBY------------------------------------------- -------------------------------------•--------------------------•- DATE.------------------•----------------------------------•---- BUILDING PERMIT ISSUED---------------------c---,�------------------- ----------------------------------- DATE------------------------------------------------------------ - - - ---------------- Alterations and/or recommendations:.---/-- .-T---:J- ----- " //' ..� -----------------------------------------------------.--------------------------- ------------------------------------------------------•--•-----------------------------------------------------------•----------------------------------------------......------------------------------------------------- -------------------------------------------------------------•---------------------------------------•------------...----------•---------•--------------•.....------....---•----...-•--------------------------------.... ------------- ---------------- -------------------- ------•--------------------- -----------------•------------•-------------------------•---------------------------- -----------------------------------------•------------ FINAL INSPECTION BY:� Date_.. _.. /f�-ls� ... S JOA UIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 911h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS