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FOR OFFICE USE: = .7------/-_ r Permit No. -./..1-7 AL� _-"" {"�{ APPLICATION FOR SANITATION PERMIT I _.._ ---- (Complete in Duplicate) Date Issued --- �3---�� ---------------------------------- A -------------------"----_.._.._- ---------------------- This Permit Expires 1 Year From Date Issued 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 No. 549. JOB ADDRESS AND LOCATION......2-SFO-------! wTD 1L. --••--• -------•-.. t Owner's NameM45-,-1.01-..------- -------------------------------------- ---------•------------------------------ •--.._. Phone_._ ---•--- Address.-•-•-•--•---(--5A-xnjE).•-•-•--••-•-•-•------------------------ •-•-••----------------------------------------•-••---------------------------------------•-•-------------•-••-•- Contractor's Name------------ ------ --------•----------•-•------••---•----•- -------------- Phone.-H•51 Installation will serve: Residence Q" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._1----- Number of bedrooms -"� Number of baths ....I... Lot size ....""s _:______! �! +t .......................... Water Supply: Public system ❑ Community system ❑ Private D,Depth To Water Table _6Q- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam i .Clay„❑_.Adobe[' Hardpan ❑ Previous Application Made: (If yes,date__.-- --------------) No b2r New Construction: Yes'Sj' No.❑ FHA/VA: Yes EDNo ET- TYPE TTYPE OF INSTALLATION AND SPECIFICATIONS: .1 '1 (No septic tank or cesspool permitted if public sewer is available within 20Q feet.)I . ., I Septic Tank: Distance from nearest well----6_j2�----Distance from foundation__._--:2--&--------Material __ _________________p ig No. of compartments---------�-----------Size--s�..•�-X_ - --?k___T.'Liquid depth_....---��--------Capacity__-e? e47 I Disposal Field: Distance from nearest well----5=q�.._Distance'from foundation-____ n__-_._.Distance to nearest lot line_.- C?.�... ] Number of lines----------------/_-----------------Length of each line------------2f>...........Width of trench----------2_9---"-"•________-_.- Type of filter material....4--CF!_C-_.__Depth of filter material------18...........Total length------------------9.142_11_..____.____ Seepage Pit: Distance to nearest well___-tjC ?__I______Distance from foundation....A1�_........Distance to nearest lot line-----a.._.____- Number of pits--------L------------Lining material_-gr.Q.t4-_------Size: Diameter------X3_._7---__ Depth------------ S".............. Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material____._._______.___.___. _..__.____. ❑ Size: Diameter----------------------------------------Depth---#------------------------------- ---------------Liquid Capacity...----------- -------------gals I Privy: Distance from nearest well------------------------------- from nearest building--------------------------._-------------. ❑ Distance to nearest lot line--------- ----------•- -• -----------��------�-- ---------------------------------- ------------------------- eli' 1 and/or repairing (describe):_____ ) 1 • h/,/� - C, ,C - &-A tf----------- _��§_-�r,!�_�'�__-..=r�pT�_�______�S..yrs�4_m__.._._____�-�"....___!'j,��P____.__..� 1 I I -------------------------------------------------------•---------------------------------------------•.................------------------------------------------------------------------------------------------------------ ! -------------------------•------ - ----------------•---------------- ------------------------------ - ------- ---------•-•------•----------•--------------.-.---------I------•-•------------- -------- 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. w --------C,_ ""_- O ner and/or Contractor [Signed}---------.D--' GL-'--- - ►. •- [ / 1 -ca<+ ---------------------------------------------------- ----------------- -- + Iritis. . . ---- By------------- l (Plot plan, showing size of lot, Iota on of system in relation to wells, buildings, etc., can be placed on reverse side). , FOR DDEPARTMENT USE ONLY APPLICATION ACCEPTED BY a� {� - -.��: ---------- DATE--- _.. . - I. REVIEWED BY--------------------------.---------- -------------------- -------------------- ------------------------------------------------ DATE---------- ! .... BUILDING PERMIT ISSUED..---------- ----------- DATE. ----- Altera ' ns d/or recommendation : �_. _a_---j'___ ��J T -� �� ---- =----------- - I I. -------------------------- - ----------------------•---------------- - FINAL INSPECTION Y: ...... - � ---- --- T ,.tA Date....��- -- •-- ------� --�-- ----------- SAN AQUIN OCAL HEALTH DISTRICT 1 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISE. 8-59 2M 5-52 ATLAS l�