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----� FOS OFFICZ USE- ............ SE--- x ---- - ---- APPLICATION FOR SANITATION PERMIT Permit No. ....�� ------ -----=--------- ---------- ---�----------------- (Complete is Duplicate) •` �; � ; . `�" --- This Permit Expires T Year From Date Issued ,Date issued ......!.............. Application is hereby made to the Sen 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. JOB ADDRESS A, LOCATION_...!_f' _- 4--.-Xc ---- ------ -Owner's N'arrte--- - -• -- -- -------- •- -- -------•-------------•---•----------••-----•- Ph ---•-------....-------••---•--------••---... Address......... ' ----------- --------- ._. Contractor's Name . '--- - = - .- Phone. .. � _:f�',�� ! :. __ Ins+allation will'serve:' ' Residence �xpar ent House ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ . Number of living units:/_____ Number of bedrooms - Number of baths --/---,Lot size ..... I .......................Water Supply: Public system omrl'munity system ❑ Private ❑ Depth to Wafer.Table,.�. '_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeEl—Fra—rd—pan ❑ Previous Applicdtion Made:+ (If yes,date------------_-------) No New Construction: Yes �j ❑ FHA/VA: Yes ❑ No TYPE OF OF INSTALLATION A'ND'SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f f•-:" l Septic Tank Distance from nearest well_, -.--e�s_Distance from foundation__/_2�._`_____--Materi I.___�'r._�,. ,• r r , i ; [� No. of coliipartrrlents.., ------------------Size. ..y - ----•-•-----Liquid depth_.,r-- -- r -------Capacity----•Xa©••••. Disposal Field: Distance from nearest well x�- ----Distance from foundation- �.._ __ istance to nearest lot line...�rj_...... lines-. .___.�.__� - .: Len tii-of each line_%�.. g �� Width of french--_ ?}=T e of filter material:. Depth of-filter material----�_�-------------Total length......,___ ....... _ _ d Seepage Pit Distance to nearest"well-_._-_.D.stance from f ndation_.�-0__......_..Distance to nearest lot line....�`_._.... F4-- Number of pits......./-------------Lining rimaterial"�,`._ ------ Size: Diameter_--,7'"' -�-------------.Depth---- \N-�.�� { . Cesspool: Distance from nearest well___ k _ oe from foundation--------_------_4._.Lining material__________________________-Distan El Size: .......... -------- ---------- ep --- ---•--------•---------•- - ----------Li Liquid Ca aci ty----------------------------gals. Privy: Distance from nearest well_`--._-- _--A___- s- ----_- _-._p.istance from nearest building g-----------------•--•------••---- ❑ Distance to nearest lot line --- - ----------- ------------------ -------------•-- ------------- _.. ::::----------------- -•----------- Remodeling and/or repairing (describe): -------------X.- .......... ---------------------------•-------- ---------------------------------------------•----------- -------------------------------- ----------------•------_--------... - - I hereby certify that I have prep red this applica on and hat the work will be done in accordance with San Joaquin County ordinances, Stafe law , and rul a pe gulatt sof a San aquin Local Health District.! t ' s -rc� �- "� (OvA! C d/cr on (Signed)-_ tractor] - - - By:... � ``-=�-------------------------------------------- (Plot plan, sh size of I oca+ion of system in-relation to wells, buildings, etc., can be pion reverse e). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. - Z.-------------------•-------------------- DATE------------- REVIEWED' BY - ------------------ ` BUILDING PERMIT ISSUED ------------- --- ------ DA•TE------ Alteraflans d/or commendafns: ----•- -- ------- - --------------------- - - ...._._ i l # - .fir- ............ l --•------ �......4f--J,s --------- l �'`�`' ------- y •�► -5 •------------------------------------------------- FINAL ---- --sem - ` --- FINAL ..INSPECTION BY:--------------- '' ------ Date---------- _ Z-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.59 2M 5-61 ATLAS