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USE ] rFIC ----------- ------------------- --------------------- ------- t APPLICATION FOR SANITATION PERMIT Permif No. _...-- ------ ----------------------- _ - - _�, l.__.1.._.... 1 (Complete in Duplicate) This Permit Expires-1 Year From Date Issued Date Issued _�L.�_] 3 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. S45.7 JOB ADDRESS AND L CATION_.-_. Ye�� - - Owner's Name_. - - --' • - --------- �j ----- PhOf18.. 1.- a /3 Address......... -- ........ �----• Contractor's Name_. - ------•-- --•--•-----_-------------•-------- . -------•----------------- Installation will serve: Residence Phone.................................. � partment House I] Comrhercial ❑ Trailer Court Number of living units: __ .- Number of bedrooms ❑ Motel E]❑ Othar ❑ „ __ Number of baths -� Lot size . �/r Water Supply: Public system -•- Y ❑ Community system �rivate ❑ Depth To Water Table Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla Previous Application Made: (If yes date____.._-.__.- Y E] Adobe�`I'ardpan ❑ ----) No ❑ New Construction: YesNo TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ ❑ FHA/VA: Yes ❑ No ❑ -' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic an : Distance from nearest well------- Qis# gym foundation_. -_..Ma eriaf-- , iC No. of compartments-----� Size a`le�`r / •------•--- Liquid depth_-- -_---------- .Ca aci Disposal Field: Distance from nearest welt..- -'--'-.--Distance from foundation_ __ / p �� 1 Number of lines_.- ,-:.---- �•---.; Distance to nearest I t line Length of each lin Type of filter materia -__.W,dth of Seepage Pit: filter material_ Depth of filt - - ---� --_-:--Total length.__ --•---•-- ` Disfance to nearest well____- - - -___Distance fr fou ation__._ _. :._/ / ®� Number of its__._ ��----.Distahnce to nearest lot li pits. ---- material_-�nSize: Diameter- Cesspool: Depth,_ Distance from nearest well.------•-_-_-- .. . --•--- --•------•---- ._Distance from foundation____.-_______----__Lining material-__.- - Cl Size: Diameter.---•- ----•------- --------Depth------------- -------•-------- ;----- ------------Liquid Capacity als. __-._---_-:------ g _______Distance from nearest building______________ Privy: Distance from nearest well ❑ Distance to nearest lot line_______________________ Remodeling and/or repairing (describe):.....__ '.. _.. --------- -------- ----- ---------- I hereby certify that I have prepared this apPlication and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules a regulations of th San Joaquin Local Health District. Y h (Signed)-------•----•-------•- BY:---------------••------ ----- -------------------------•-------•�--------`----------- --• r Contractor] (Title) - (Plot plan, showing size of lot, location of system iq r ion to wells, buildings, etc., can be placed reverse s de). R DEPA ENT USE ONLY APPLICATION ACCEPTE ._ REVIEWED -- -- - --- --- - - -- -------••-------•------------ DATE_. " BUILDING PERMIT ISSUED_____________________ DATE___._.__ DATEAlterations and/or recommendations:_ FiNAL INSPECTION BY:_-- --- - Date__--- SAN JOAQ LOCAL _ ALTH DISTRICT 130 South American Strut 300 West Oak StreetStockton,California 124 Sycamore set 205 West 9th Strut Lodi,California Manteca,Ca formic ES 9 REVISEU 8.59 2M 5-62 ATLAS 1y,California, 0