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FOR OFF IC�SF: ----------------------- - ------ ----------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .1.................. -�- �-- - (Complete in Duplicate) - fpJ- -.--. This Permit Expires 1 Year From Date Issued Date Issued _______________________ 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. 1 j JOS ADDRESS AND LOCATION--------------- ©_.�b-.----------------------- -------- ..---- �, /I--f- Owner's Name------------, � ........S&71- --------------------------------------- ------------------------------------------- Phone.......------------.---•---_----- Address.........S'zzy.°-._._ -------------------------------- Contractor's Name---------•------��-/Q `' �L� r- ------------------------------------------•-------•-------••--•--- Phone................................... Installation will serve: Residence 2( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms __A_ Number of baths __.l__ Lot size "t, "- ,-4 __---------_-------------------- Water Supply: Public system ❑ Community system ❑ Private g?"Doepth To Water Table Z0494. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ 'Clay Loam ❑ Clay ❑ Adobe(Hardpan ❑ Previous Application Made: (If yes,date--------------------) No A,/ New Construction: Yes ❑ No g FHA/VA: Yes ❑ No E OY TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t k Septic Tank; Distance from nearest well-----------------Distance from foundation--------------------Material_________________________________________________ k� No. of compartments ___Size____.-----------------------,_.-Li uid de th__----__-..-_-...._ __Ca Capacity ILA Pq P P ty Disposal Feld: Distance from nearest well-__-_____---Distance from foundation____`r-i______==Distance`to nearest lot line.-............... s <'� Number of lines-----------------------------------Length of each line-----------------_:----------Width of trench-------•-----------------------•- Type of filter material----------------------.__Depth of filter material........--------'-_.__Tota! length__^_________-_-___-_______-_-_____--__._ Seepa ' Pit' Distance to nearest well___1"JI��_-___--Distance.f m f ndation__j4_....r.Di tan4ce to nearest lot line................. Number of Its___. __ _Linin material. Sixe: Diameter___. _. 1Tr _�. _. le _ P g -• -------- Depth Cessro-o� Distance frorti?nearest well--------- from foundation--------------------Lining material-~_..------------------------------ Size: __-_____________ .._ Size: Diameter----•---------------------------------De th--------------------------------------- -----------Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_____�t_______________-_•__________..._. ❑ Distance to nearest lot line------------------------------ =------------------------------..._------------------------------------------------------- Remodeling and/or repairing (descnbe): = = ----------?---------=---------------••---------------- --------------------------------------------------------------- -----------; ------------------*------------------------------------------ ---------- --- --- ---- -;r ----------•---------------------•------------------------------------------------------------ ----------------------------------------------------- ----:------=---•---•----•-------- ------------------------------ I hereby certify that I have prepared this application and that the work will be done'in accordNnce with/San Joaquin County ordinances, State laws, and r les and regulations �of)the San Joaquin Local Health District. (Signed).................• :. - Am Contractor) ---- t . r r By---------------------------------- - --- 1'------.(Title) `� --------- ........ ----------- (Piot plan, showing size of lot, location of system in relat' to wells, buildings, etc., can be placed on reverse side). { FOR MEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- > -------------------------- DATE--- Q - REVIEWEDBY------------------------- --------------- --- -- ----------------•---------------------------------------------------------•- DATE----------------------------------- --•-- BUILDINGPERMIT ISSUED-------------_-- ----------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or rec mmendations: ---s- ••--••--•---- •-•---------- I —1-�, 12L.— (� 1 6 - ffL ----=-------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:j - Date._.._�_6: .�...r 2— ....................... ,SAN JOAQVIN,LOCAL.HEALTH DISTRICT 130 South American street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ' M nteia,Cailfforn a> Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS _ .lr �� I