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FOR OFFICE USE: 2 p- Q' 41----�---- -- - 3 --- -------- 3 05\7 - -3_ _ APPLICATION FOR SANITATION PERMIT Permit No. . .... f3�--.--- ---- (Complete in }Duplicate) � - - Date Issued :1_.... This Permit Expires 1 Year From Date Issued I; x Application is hereby made to the San Joaquin Local-Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinan eN 49. ! � JOB ADDRESS AND LOCATION----- 4/w kms.----------s-----. ;!............... Owner's Name � ----------- p ------•--- Phone............�......... Address---...--._R1 ..Zio............ .... ------------- "` -------......------------------------. i ----•--- i - Contractor's Name.. ............... Phon ._.. .........�� { - " l R Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer• o rt ❑ Motel ❑ Other �+ Number of living units: ........ Number of bedrooms -------- Number of bat sl a .... •.............fir Water Supply: Public system Community system [I Private E) Depth To Water Table.6-4040 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe§a Hardpan ❑ ` Previous Application Mado:'(If yes,date--------------- No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted ' blit se or is available within 200 feet.) l r 1 Septic Tank: Distance from nearest well __ Distance tom foun�{ation_/>�.'______.Mate�aL - ---------I1,14t I ' No. of compartinenfs-_-41----------- Size q-----g--------.Liquid depth...Z/- ------Capaci+y.. Q� �A Distance to nearest lo+ hne.. _-__---.- D'+sposal Field: Distance from nearest well__ Da of each I ne__atio _ Width of +ranch_______ I / ti, j Number of lines Length Type of filter ma#eriaLSt- p of filter material____ Total length �!--------- ........ --------- g De th r II Seepage Pit: Distance to nearest well��r�' -_�Distan a om*TfL ndafiion____ ....-.._ st n +o nearest lots line_�_,�__...... Number of,pits------/-------------Lining ma+erial e.C ----Size: Diameter.--s�.. - '.Depth------ ..................Cesspool: Distance f.4omnearest waif------------=----Despt+Ince from foundation Liiquid Capacty._____.._.I g❑ Size: Diameter._!_____________ --------------_- -____-Distance from nearest buildin ___________--""•" els. F= Privy: Distance from nearest well_________________________ g----------------=--•�•--.•••------ ❑ Distance to nealrest'Ibt line ------ ----------- ------------------------------------- �i -------•------i, Remodeling and/or repairing (describe):---- - --- --- `I—-f - n - k- I ------------------------ ------- - 1 hereb c rfif hat I h e repared t ' applic +ion and.fhaf +he work will b e in accordance with San Joaquin County ' ordinances, to ws, and rule and regul on of +he San IJoaquin Local Health istrict. I t *-e ' �(Signed)------- --- ------------------------------- [ _ --- - -------------- ---- ----- .------ ------------------------------ wner and I,or Contractor) - -------- rtleBy:----------------- - .. - - - { 1I(Plot plan, showing size of lot, Iota}ion of system in re ation tngs, efc., can be placed on reverse side),II FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____'_ ------ t C - - ---------- .. _. . _ DATE A - -----•------------------ - -------------- --------------- -- ---------------- REVIEWED BY--- ---------------= --. -•---._.. DATE-------------------- I BUILDING PERMIT ISSUED------------------------------------------------------ DATE.------_------------ and/or recomm ations•____________ _. c. :.....,.. � ••• ------------------------- Alterations ......._.._ � c~ •�--------=/ - -�- �` r�� ---------------------------- ;I --------------=--•----------------------•--.----..-----------------------------------�------------------------- --------------------------------- ---------- --------------•------------------------------ ---------------------------------- 11.1....1-------•---------•-------•---------- i FINAL INSPECTION BY:... J.- ___________________ Date__.... .-------- ---------- -- ---._ i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California I ES 9 REVISED 8-59 2M 9.62 ATLAS