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VUrc Urrluh ust=: \ ____________ ------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ...................... --------------- --------------------------------------- (Complete in Duplicate) -------------- This Permit Ex ires 1 Year From Date Issued 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. /32 p�j— &C,.3 boa t ,A: N>Ecj77-0 c--/ tea. JOB ADDRESS AND LOCATION... ,��- Owners Name---. -•- -- ----......... ....... �. Phone.................................... Address-------------- r�� rL Contractor's Name--------------------Z.-F42.-Z...-& Xi_1.......-----------.......__...--------------•--•---...................__..__ Phone..-•--------------------••-------_ Installation will serve: Residence ❑ Apartment House ❑ Commercial grooTrailer Court ❑ Motel ❑ Other ❑ Number of living units: _"__ Number of bedrooms :?�__ Number of baths .A�_.. Lot size --e� ...................... Water Supply: Publics stem y ❑ Community system ❑ Private PRIVepth to Water Table 4/0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[ZJ/Fardpan ❑ 4 Previous Application Made: IIf yes,date--------------______l No [ "New Construction: Yes Z?-No ❑ FHA/VA: Yes ❑ No F�j— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r S-ptic Tank: Distance from nearest well.____�,0 ---Distance from foundation_____ -- Material--- .... [LY' No. of compartments_.____..2_______..'_Size-t;�K�X__1V__.___Liquid dep�h___��lC !.---------Capacity---9Q_V...... Disposal Field: Distance from nears ell--AQf._.. Distance from foundati n_._.. . Distance to nearest lot Iine..b�. ....... ®� Number of lines______________ Length of each line.. -__._____�`______-.Width of trench..._e�_ __.�___ Type of filter material -Depth of filter material__!' ___________.Total length_______.-,�i> ------____.__ Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line__._____......... 1-1 Number of pits______________________Lining material-----------------------Size: Diameter------------------------Dept h__.__.-...._.____-__.._______---_ Cesspool: Distance from nearest well_________________Distance from foundation------------.-------Lining material--------.-----------.---------------- -❑El Size: Diameter------•-------------------------------De th--------------------- -----------------------------Liquid Capacity............................gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building,--_________________--_-__---_____._-_.._. ❑ Distance to nearest lot line--------------------------------- --------- ------------ Remodeling and/or repairing describe :_______. _Y f/ '__. r -_.___ !G. - Wv ' ---------------------- ----------------------------------....... _r. _..... ..._..,---i-.._L--/-�j}'----•-'___....e0y-------/--/- -.. ,../-------------------------••---•---------..._-•-------------.----- ----------- -- -----------�!_{�t�+" , .-404.;/_ -,J�F•• d�l�l_r_L!-•---G�= _=�---__.._._----•---'-----••----.....- -" . -------------»_._....-----------------------------------•-•----------...---------•---------------•--•-----------.----.-.------------------•-------------------•---------------..._..-.-.-•---------.----•----------------- I 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, '.4 {Si reed Q � 9 )--------•--..... f+� --- z• - ----------------- By: Contractor) B :__..._.--•.................................................... Title__._ Y ............. (rifle) ..6ftt�/0C1_4 1------•------ ------------------- (Piat plan, showing size of lot, location of system in re ion to wells, buildings, etc., can be placed an reverse side). `5611 DEP TMENT USE ONLY ` APPLICATION ACCEPTED BY_._____.____._ ------ u' - ------------ DATE....--- REVIEWEDBY------------------------------------ ------ •--•--•-----------•------------ DATE----------------••---------------------- BUILDING PERMIT ISSUED — DATE ti.. Alterations nd/ r recommend'ations:.,�s-2�_":_�,_�---_-1 ---1_l lam_ - ----- --------------•• -•-_ ------------------------- - - ---L-x--------S --.-------- ------------- -- ----.. ------------------------ ----------------------------------------1------------------------------ ------•--••----•--------------------- I-- --------- ------ FINAL INSPECTION BY-- - ----- - �f ,�.,... ..---- Date---------------- _- _-f"'—-- SAN JOAQUIN LOCAL HEALTH DISTRICT N, 130 South American Street 300 West Oak Street 124 Sycamore Stmt 105 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.99 ZM 8^61 ATLAS '