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rVKv%rll fit: ------ - ------------------------------------ _ - ________ APPLICATION FORS SANITATION PERMIT Permit No. ..,�.J�..—.�.Y-_� ------- --------------------- --------------------------- (Complete)in Duplicate) ------------- ---------------------- ----- l 3z ate Issued r) — --- "- This Permit Ex fires 1 ,Year From Date Issued -F---- •-•�--— V 2x —tf 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. S49 JOB ADDRESS AND OC TION ��/ -- 14A t Owner's Name------ _ i ------------------------ ------ ---- ----._ Phone------------_------- -- Address__/ ,� ------------------- Contractor's Name ----------- -- -•- - -- -----•---•------ Phone................................ - Installation will serve: Residence ❑ Apartment House ❑ Commercial Tr ilei Curt WOZ ❑ ❑ Motel ❑ Other �� Number of living units: -------- Number of bedrooms _____._.. umber of,baths�'�t size .4ve----____------ - Water Supply: Public system ❑ Community system ❑ Private �e_pth To Water Table 6-V ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClaY Loam ❑ Cl_aY ❑ Adobe 0--'Hardpan ❑ Previous Application Made: llf yes,date-------- _----------) No ❑ New Construction: Yes10 ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p Septic Tek: Distance from nearest well__, _ '---Distance) from foundation.... ' l No. of compartments-.-_c2-----------------Size_.r�'��.-_t�_.6_----:---Liquid depth---y--lam"-----_Capacity-_9_40.0_ Disposal d: Distance from nearest well--- Distance from foundation__ /O.____..._.Distance to nearest lot line. C ;_.�.. Number of lines------- _. _ ____Length of each line___..c�®________________Width of trench.-__ Type of filter material.-5,_ _ 110-*_Depth of filter material___,/__-�`----.Total length___________________ Q_i_.._ ' �I ---- Seepage Distance to nearest well1�}Q`-------_Distanc�m foundation__-/Q_,f-_._. (stance to nearest lot line 8040 ,� r Number of pits- ________--;Lining material__ _( C./ -.-Size: Diame+e r.-._ . 3 Depth______ _-S�_________________ ----_.. Cesspool: Distance from nearest well-________________Distance from foundation_..._:.------------Lining material.._.___-_______.--._-_____-..____._-- ❑ Size: Diameter------------------------------ -------Depth-- -�------------------------------------------------Liquid Capacity-------_-------•--------•-gals. Privy: Distance from nearest well-_____________________________________.____.---_Distance from nearest building ❑ Distance to nearest lot line_____ Remodeling and/or repairing (describe):____ -- ----- �- --------_r _ f2 ------------------------C _______________________________________________F -----------------___----------------------------.__..____�___-.________-.____ _ ! hereby c ' that I have prepared this application and that the work will be done in accordance with San Joaquin County • a ordinance;;, to 1 s, and rules and regulatio of the San Joaquin Local Health District. Si ned i ---- -- - - -- -- -- ---- - ( 9 }-- -----�------- - ----- ------------- - --- -�-.------ --- - er and/or Contractor) 4 $Y�= ----(rtle)------ (Plot plan, showing size of lot, location of system in relat n to w is, buildin , etc., can be laced on averse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____ _ __ _ - II /--- __-.-- DATE_._.-. " -------- - VIEWEDBY -------- •---------- -------------------------------------- -----•---- --------- - DATE------------- --- .---------------------- BUILDING PERMIT ISSUED------------------------------------ ----- ---— ••-rt1 t DAT?E- / . ---Alferati and r recommen Mons:-__ E- _ _______ ___•1rfJv ----------------------------------- --------------_---------------_------------------------------------------- ______________________________________________________________________________________________"_--..-______-_.________..__-____.-_._____-__.___-.... -----------------------_....... _.------------ ------------------------------------------------------------- ______________________________ ..............�._________._.____.__--_-_-_.. ----------------------------- FINAL INSPECTION BY: -.----.. .-Ga- _ --------------- Date-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak StreetH 124 Sycamore Street ° 205 West 9th Street Stockton,California Lodi,California Manteca,California i Tracy,California ES 9 REVISED a-59 21A 5-6Z ATLAS