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FOR OFFICE USE: r Permit No. _._. .. ----------------- ------------------------ ------- ----------- --------_ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) - --------------------------- ....... .......' -_ ..___._._ This Permit Expires 1 Year From Date Issued oats 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......qR.0_1........o .�_✓q_ L E -----•--------------------------------•-----•--...._.------------------------••-- Owner's Name_.---`? &.6�.Y..----...5 .N_2_J .R.1--------------.."------------------------•-----------------------------"-- Phone..:....----........................ Address---------pz-a-= J�PA.....$.> 1-----------------••......sl�_l jo_9 -----�d L 1, D ........................................... Contractor's Name..---, ` A----• r`� }i212f. ._H..0 —S-6A)-S --------JNQ-n---------------------------- �713��.g., ' 1 Phone..-_ . " Installation will serve: Residence Apartment House-E]7 omrhercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/---- Number of bedrooms'.-2---Number of baths ----/.. Lot size ........)____0_....__�._... ............... Water Supply: Public system 9--Community system ❑ Private ❑ Depth To Water Table .4v ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ['Clay ❑ Adobes Hardpan ❑ Previous Application Made: (if yes,date.-------------------I No [""New Construction: Yes ❑ No E-'_"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---------------- Distance from foundation--------------------Material-----------------------------.............------- I ❑ No. of compartments--------------------------Size-------------------------------Liquid depth-------------------------Capacity....................... Disposal Field: Distance from nearest well.IVON&,.Distance from foundation.....ZO.......Distance to nearest lot line-___S._ .... ® Q�Q� Number of lines_____________./------------------`Length of each line------,!_�-r----------.Width of french--------------.i__-_"...... Type of filter material._r/`yC/_C__gDeph of filter mafierial .26_`------Total length__..............1-.5.___'__________ Seepage Pit: Distance to nearest welllel4 _ ___Dista rem #ou ation__- ___a ._....Distance to nearest lot line_______--_._ ® Number of pits------)-------------Lining mat ial...i�o _/L-Size: iameter.......3-K....__.,Depth----------� _.-.'._.__...... Cesspool: Distance from nearest well-----------------D tante from fo ation-------------------- material------------------------............. F ❑ Size: Diameter--------------------------------------Dep ----------------------------------------------------Liquid Capacity----------------------- --gals. �l Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----....__-_.---------.--,---__-_-_-----. 'll ❑ Distance to nearest lot Nne--------------------------------------------- ------------------------------------------------------------•--------------..:-... -------- k Remodeling and/or repairing (describe)------------ ......_,e._ ': ..••-.--.-•.-.-••.................•------------•-------•--------•--------•-----------•----------------------------------------•---------------------------------------------------:-.-..--.-••---•-.---. ---•---------•--- ----------------- -----•----------------------------•-----------•--•-----------------------------------------•-•-------------------------------•-•---•-----•-------•--•-------------------------- 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. « - D (Signed) ... ......... .:... `,' r f � -------•-------- '"�`— {Owner nd/or Contrector) BY: ------------------•--•-•-------- Title . ...=-¢------_--=•------------- --- { (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - - - f -- ------- --- -- - DATE •� dr+-: ------- REVIEWED BY----------•---------------•------------------------ ----------- ---------- DATE BUILDING PERMIT ISSUED---•----------•-- -----------------– ------------ . �TE -------------------------------------- Alterations and/or recommendations:_ ____._ .............................------------------------------------------------- --------------------------I-----------•""-- -•-------•--•--"----------------------- -................... --------------------- ----•-----• -- --------------••---------------------- -- ----------------- --•---------------- - - i1 t FINAL INSPI=CTION BY: ` Date_/--.-- ----------- SAN J QUIN LO AL HEALTH DISTRICT 130 South Am►rican Street 300 Wool ak Street 124 Sycamore Stree 205 West 91h Strout Stockton,California Lodi, alifornio Mont*co,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS