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" , '--- -- ¢ APPLICA ION FOR SANITATION PERMIT Permit-No - ----------�F_6------ ------ , l ----- (Complete in Duplicate] Date,Iss'ueAi-__7,l I -------------------------------- ------------------ _ - This Permit Expires 1 Year From Date`Issuedyr, 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 No49• s✓ lid JOl3 ADDRESS A. O ION --------------------------------- -- --------- --- - I _ ------- Phone'. dada •} �} Owner's Nam •---�.._----------------•--- a . . . t i�f ............................................................. Address-.._ .. ,� Ph ---- one------------------••--•-------- Contractor's Name-------------- - -�- ---•-�'•••----. -- ---•------=•-• ----------•------------------------•-----_-----•-----------.... l \. 'Iristalla+ion will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �� i *' Number of living units: ._ ____ Number of bedrooms _�- Number of baths __-..__ Lot size __ ...w _.-.- --- i g ❑ Y Y p � ft. wti er Supply: Public system Community system ❑ Privets e th to Water Table Character of soil to a depth of 3 #eI Sand [I Gravel ❑ Sandy Loam ElClay Loam❑ Clay F] Adobe ardpan ❑ ` I ] No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ Previous Application Made: (If yes,date."-.-_"_.----------- I TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I +_. " --------- Septic ...... Septic Tank: Distance from nearest well -P-_---._Distance from foundation_ _.. r-No. of compartments - 5ize_�d--------- A,_ --Liquid depth------S----------------Capacaty..,��.��- i Disposal Field. Distance from Weare t well _ `_ Distance'from'foundation-�` �:� -"Distance'to �leaiest lot line_.._.._____ p merits-.- -"" P f r ev n Number of lines - _. -___ __ Length of each line;�._ �--- --•Width of trench--. ._-- ..._ -. Type of filter itiaterial�r_ ___ Depth of filter material---- -. -Total length--------- _____________ -_--__-_.-- ' — T t ndS ze:nDiameter_" Distance to nearest lot line-----------_--- Seepage ________________ P 9 Number of lits.... Lining material---------------•--I -- ---_-----_--Depth--------------------------------- - See a e Pit: Distance to nearest well_----�.-"..._.+ ❑ _ Distance from fo Py� i r e � - Cesspool: t Distance i-from nearest well-----------------Distance from foundation.-.-----_-. ---.Lining material.-----.-.---:_- ❑ r e el r '. . -Depth---------------------------------------------------Liquid Capacity gals. Size: Diameter-'............. --------- E. tq , P tY-----•-•----••-------------• Privy: Distance from nearest well-----_------__--------------------•--------I--Distance from nearest building-----..________.______..-.------__•____-•• ❑ Distance to nearest loft line-------------•-------- ------------�f------"- f {, 1 Remodeling and/or repairing (describe)- l �¢ ................. ' ------------- ---"------------------------------- -------.---- --•-----•---•-•----------------- -----•--------------------------------------------------------- s i # " = -------------------------------------------------------- l ----....--------------••-._.-----------•-•---------------------•-------------------- i I hereb }e 'fy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances ttatwlaws, and rb s and re ulations of the San Joaquin Lo6ai l Health District. (Signed)--- - _ = --------------- Wer and/or Contractor] tj By: ._-...... - �-- ------ ---- t `'�`" �Ti+lel -------- -- [ (Plot plan, showing size of lot;.location of system in relation to wells, dings, etc., can be placed on reverse side]. i t R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.-.-i.. °` --�-- 1-----•----------•--------•--- DATE-------- ------- �--------------- REVIEWED BY----------- ••-----.-•- -- - -- DATE BUILDING PERMIT ISSUED---- ------------ --------------------------- DATE Alterations and/or recommendations:---------------------------------------------- ---------••----------•---------------------------------------- -------••------ d ------------•-"-•-------•-----------------•------------------•-----...----........ ----------------i------•-----•-----------•--------•-------•--- ------------- = -----------------•-----•--- ---•--- --------- I - C_ FINAL INSPECTION c.-__ Date---_------------ G. ................................... If SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 Wert 9Th Strut Stockton,California Lodi,California Manteca,California Tracy,California ' ES 9 REVISED 6.89 2M 5-61 ATLAS