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rUKVrt-R-L u5e: ---"""� - --------- -------------------------------------------------------- "APPLICATION FOR SANITATION PERMIT Permit No. f ------- �'--!°------� --------------------------------------------- ------ (Complete in Duplicatel --- ------------ ----------- - ----------------------__ I This Permit Expires I Year From Date Issued Date issued Z!�/ / 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----------------• '_ _�:_---____------ �'�' Owner's Name--------- � �.� ter. . _ z:B! I` �' Contractor's Name_---•----•---------------_--- �.., � v --•--•--------------------------------•----------------._....... Phone................................ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ .Other [2 Number of living units: _*-f.. Number of bedrooms -------- Number of baths ____�'._�_ Lot size .__.._ _ .,<..., .................:.. Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table-.Z--`?It. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ®' Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: ilf yes,date---------7---------1 No El Now Construction: Yes [:1 No [X FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__.w�---__-_Distance from foundation__f.P-----Material... �- ;_- ,-••• .- rn Pte' No. of compartments-------*-7--____..__-Size -_ ..-________Ca Capacity.,3 Li uid de th__....�_ -" $ Disposal Field: Distance from nearest well_______ --------Distance from foundation....:X�..�"....Distance to nearest lot line...... ..* Number of lines__________________ __ - - ---------Length of each line---•---•---��-----�=-----.Width of trench-------------I—---------- -•-•--••-•- Type of filter meferial._. _ate,.Depth of filter material__L. ..... length-------------------8'_47._..,,__ .. Seepage Pit: Distance_to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_-.-..__-__.___.- ❑ Number of pits----------------------Lining material------_----------------Size: Diameter------------------------Dept h--------------------------. - Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------......................... ❑ Size: Diameter--.--------- ------Depth-----------------------•--------------•--•----------Li Liquid Capacity . - q P tY----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-________-_._---___._-- ❑ Distance to nearest lot line ��----------------------------------------------- - Remod ing and/or repairing (describe):__-------C��. . G..�...� w .- _ f 14-1-1 .0 ` 2�tr ��'s'4^ ------ --------�'�� -�- __:.._. /! ./ f----------------------------- •-----•-------•-----------••-•-----------f/--------------------------•--------•--- -•---------•-----•------•-------------------•---------•------------------ -•----------•------•--...._----------------------------------- I hereby certify that I have prepared this application and that the work w.41 be done in accordance with San Joaquin County ordinances, Stat s, and rules and regul tions the San Joaquin1ocal.Health District. r-- (Signed).... ... -. i :---------------------*---------------------------------------------(Owner and/or Contractor) k By:......................................................... -.....-------•--------------------_------------------------------------- n be placed on reverse side). F EPARTMENT USE ONLY APPLICATION,ACCEPTED BY--- -��`-� - DATE ,c ! REVIEWED BY `'------------------- k. DATE ----------------- ---- ---------- ---------------------------• 1-------------- BIJILDING PERMIT IS$UED------------------------------------------ ----------------- - ------------------------------------ DATE Alteratio and/or`recomm6ndations:--------------------------------------------------- x -------------------- �- � '� ------------- 3rtlG,;- --u ........... s / ' Vis. uL ?/�... l S ,,,.,.. FINAL INSPECTION BY: c ;sCQx ----- --� Dete..__..._ �� `�� w � USAN JOAQUtN'LOCAL HEALTHIp STRICT�� 130 South American Street 300 West Oak Syreet ]2q Sycamore Street r 205 West 91h street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.99 ZM 11-61 ATLAS # .,�