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rUKVr*NUt USt 9 -------------------------- ----------------------------------- ------------------ APPLICATION FOR SANITATION PERMIT � Permit No. ------------ ------------ ---------------------------- (Complete in Duplicate) This Permit I:x fires Y Year From Date issued Date Issued Application is hereby made to the San Joaquin Local Heaffh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. C>r c .'4 JOB ADDRESS AND LOCATION-.�-� _---_ � Owner's Name.---...D 4A'I /, p ----•----------•-------------• ---------- -- --. Phone...................... ...... Address............U._ Contractor's Name...,�.,.��. -�?:G__-_-______• •_ __ - Phone................. Installation will serve: Residence ] Apartment House E❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units::_/----- Number of bedrooms _z Number of baths ._._ Lot size _..l#._6 .'-----•--------------_----- Water Supply: Public systems❑ Co1. mmunity system ❑ Private ® f]epth ro Water Tabled #t. 'Character of soil to a depth of 3 feet: Sand ❑' Gravel ❑ Sandy Loam [3 Clay Loam JB Clay ❑ Adobe Hardpan E]yes Previous Application Made: 11# ,date._----------- ---- N 1 o,� New Construction: Yes e No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer va ailable within 200 feet.) •i Septic Tank: Distance from nearest we11.._ d..__..Distoncfj from fOLlnddtlOn-A--.-_-_....Material.- 120 No. of compartrrients-..-.a --------•---- Sizj6/r'fi_��'_%S�----Liquid depth---- --------- ---•---Ca acs},�/,2-� Disposal Field: Distance from nearest well__4�---. -Distance from foundation.._e G`---------Distance to nearest lot line.4f_.....__ Number of lines---&2...... ... ..-.-Len `th of each line-------- - g - Width of trench.-rr2�f..................... T e of filter materia - YPl .Depth of'filtertmatenal.....�-Q_ ......Total length..dZa-ts_ ---------•------.----•- Seepage Pit: Distance to nearest well----------------- from 'foundation....................Distance to nearest lot line......-.-__-...._ ❑ Number of pits. ------Lining material----------- -----------Size: Diameter----•----------------- Depth----------------•---- -- Cesspool: Distance from ^� ❑ Size: Dia menearest well from foundation.-__--..._-.------.Lining material..----..------. ter------------------------------------•-Depth--•-•---------------------------------- -----•-Liquid Capacity ale. -----••------------••--••--g Privy: Distance from nearest well------------------------------------------------Distance from nearest building [❑ Distance to'nearest.lot line----------------------------------------- - Remodeling and/or repairing (describe:...__................. ---------------------------------------------- ------------------ ---------- ------•---------------------•------------•----------`------••-------•-----------...------•------••-- --- _.-----...--------------------••--------• ---- ------ hereby certify that I have prepared this application'and that'the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i ' t (Signed)- ---------- -- --------------------. --------- ------------- ------------------------- ------------------------------- -(Owner and/or Contractor) By:- — _- -�.:. s = - {rifle)---•---------------------------- (Plot plan, s owing size of to+, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_'. _.. . - - -._--. DATE_.1�„ �-- ., ---•.-_ ---------- ---------- ------- ------------------------------------------------------ REVIEWED BY---------------•-------------�--------------- -----------------`------------ -- ------------ •- ------------ DATE . BUILDING PERMIT ISSUED-------I-------------- ----------------- ------ DATE.....................- --------- Alterations and/or recommendations:---------------- -------------------------------------- ------•--•--------------•- --...11. -------••------------------------- - 10 ------------------------------------------------------ ---------------------------------- FINAL INSPECTION BY:. ._ -. - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak SrreN 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5.62 ATLAS" ' 4