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FOR OFFIC USE: �-{{ Permit No—/...�f�- f - APPLICATION FOR SANITATION PERMIT - ------- - '---_--;-„----- lit •----------------- (Complete in Duplicate) Date Issued __--_----___------ -------------.---..__ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 1 ----------•----------................ JOB ADDRESS AND LOCATION.}___..:/--®-�----- -- ••- •---•-- ------ A.Zl�------ - '�.��J -----------• Phone....-----=77- Owner s Name �f s ------•--------- - I ................... Address.....................-------p--• - --------------------------------- ............................................••-----------•--------------- lContractor's Name__rJ - /c- ----- �.._ ..----•-•--------------•--•-------•-... Phone Installation will serve: Residence -tApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ../_j:INumber of bedroorris Number of baths . Lot size -------, .._�...lC_____.l Water Supply: Public systemP alCcmmunity system [3 Private [-] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [3Sandy Loam ElClay Loam I- Clay ❑ Adobe a Hardpan ❑ I Previous Application Made: (if yes elate-_.__--------------) No ❑ New Construction: Yes E] No FHA/VA: Yes El No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se or is available within 200 feet.) Septic Tank: Distance from nearest well_ Dista e� from �oundatn___ .p___ ..._.Mate ' I 00_______________________ K1-1 p nts ------ Size 7--�C`j Liquid depth Capacity--—--- . ... No. of com artma Disposal Field: Distance from nearer+ wel_ .-.Distance from foundation_0------ _.Distance to nearest lot.line....... Number of lines________ _ _____ ______ Length of each line_.-� f�Width of trench___.c - '!--__...___.-- •Depth.of filter material__ _ Total len th__________ ____ Type of filter materlal_�a_ -_ �-��-' g •� --'-'•"'•-'--�: See a e Pit: Distance to'neare t well_ s.�---Distance from foundationQZ.40..----Distance to nearest lot line___-&---__._ Number of pits__.I_________________Lining material_-. ._ Size: Diameter_ � 6f _.,Depth- f._______..._______----- I Cesspool: Distance from nearest well-----------------Distance from oundation---.----------------Lining material..----------------------------------- ❑ Site: Diameter--------------------------------------Depth------------------------------------------------ ._Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------.____-___-- ❑ Distance to nearest lot line------------------------ ----------------------------------------------------------•-----------------------•--- Remodeling and/or repairing (describe):________________________ _____ __________ --•----------•- f ---• ------------ --------------------- -------- .................. - --------------- - - -- - ---- •-•-•-- ............... ..... i ------------------------------------------- Ir— - ---------------------• -- ----------------------------- --- I ---------- --- - -------------------------•---------------•-•--------------------•---••--- ---- --- - 1 I hereby cerlify that I have prepared this application and t the work will be done iri ac rdance with San Joaquin County 1 ordinan es, Sta ws, d rules and re ul tions of the San J qui Local Dis ict. � Cbntractor] ( g 1----�- --•-•------ - --- ....... (Plot --`°"'�-.•- --- --� --- - ---•f tile---------.�-------------------------- ---- -�----------- (Plot plan, showing size of lot, location of system in relation to wells in , etc.,.c be placed on reverse side). FOR DEPARTMENT USE ONLY' APPLICATION ACCEPTED BY-------- ` rJ/-- 0 �,.�•J ----•- DATE_------•--.` REVIEWEDBY---------------•-----------�� •--------- - _ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED....�-.............--------------v---------------•---------------------=•-------------------- DATE---------------------------- --------�-. ..----- - ---- Alterations and/o recommendations:.__//. `. - -•• ...--•�” r` "''� y-� -- + a - ----- --- - ------------- 4V CA f6�� _ FINA�SPEC;TION Y:. __.... -- -------------- Date- ----- -------------•-- ----- -- ' '_'?_ � SAN JOAQUIN LOCAL HEALTH DISTRICT � 130 South American St eet 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 Stockton,California Lodi,California Manteca,California Tracy,California E9 9 REVISED S-99 YM 6-61 ATLAS 1[ -41 - -- _-