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T FOR OFFICE USE: r v tt APPLICATIt�N FOR SANITATION PERMIT Permit No. .�i. � �- if-� ---------- // ------------------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date slue Application is hereby madie 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. div No.t` 9. q "6 �¢"� i JOB ADDRESS AND LOC ION----------i �-"- . Phone------------------------------------ Owner's Name----------- --- -- - cx,�.t � -----------•-------------------------- t ---- . •-------•-------• -------- Address-- a1'_ �-�� •--- Phone........•--...•--------------- Contractor's Name---------- , �'�'----- Installation will serve: Residence [}partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - ------................ Number of living units: ."�____ Number of bedrooms_L---- Number of baths Z—_- Lot size _.�_s,�_- -�,�. - I Water Supply: Public system excommunity system ❑ Private ❑ Depth TO Water Tnb1e ;7_ ft. 1 Clay Loam ay ❑ Adobe�ardpon ❑ Character of soil to a depth of-3 feet: Sand ❑ Gravel ❑-Sandy Loam ❑ Y ❑ i rrNo ` '--Preyious Application Made: (If yes,date ___________________) No �ew Construction: Yes o ❑ FHA/VA: Yes ❑ ! TYPE OF INSTALLATION!AND SPECIFICATIONS: .w., (No septic tank.or-cesspool permitted if public sewer is available within 200 feet.) $e tic Tank: Distance 4om nearest well___.__° __.-__Die#ante from foundation__---__.______.Ma�evial____ -•�C_.---.___". P ; Capacity No. of compartments-.-_2 _--------------Size.-- � L" l_1 -----Liqued depth" / r t .. - Disposal Field: Distance from nearest-well_..- _ Distance from foundation./-R.._�___..._.Distance to nearest lot 1ir;e" _...--•-- I CRS __ Number,of lines-------•--�'----*�-- •-- Length of each line--_7 +�+t__.-----Width-of-trench,__ .y-• --- yp --�� De th of filter mater�aI- -------------- otal length------ r------------------------ Type •---------------------- T e of;.filter mater-ial._._.-r� p Seepage Distance to nearest well____`"'______________Distance from foundation__. _�� Distance to nearest lot line._��----- Number of pi+s______- •----- Lining material__1r`oc --"--$ii Diameter-__3- "-_------.Depth---s��5-�-.------_-------- Number •- ------ z } Cesspool: Distance from nearest well-----------------Distance from foundation_-.______"__...__..Lining material___._____...___.__..___..___..._._.._ U . Liquid CapacitY------------•--•----•--- gals. v ❑ Size:_Diameter------------- -----------------------Depth-------•-----------•------------------------------ =- —:----._Distancefrom—nearest-building-----•---------"------------------- once a from _earest well _.._____"; f Privy: _.— - x.. ----- ❑ Distance to nearest lot line--------------------------- -----------------------•---.------------•------- �. ----------- -------------_- ----------- Remodelingr and/or repairing (describe):---------- � -- r --------------------------------- ------------------------------------------ J 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 end regulations of the San Joaquin Local Health District. .I l (0 5 caner and/or Contract - --Z• I ------------------ -------------------- (Signed) o / --( d o , � ----------- - _ - - -- --- -- - Title /-- build'1ngs, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system in relation to wells, - i FOR DEPARTMENT USE ONLY r ----------------- APPLICATION ACCEPTED BY______ "�------- -- ----------------------------- DATE_.. L� DATE...------------------••---------------•------------- ( REVIEWED BY-------------------------------------------- •------------- --- DATE PERMITISSUED------------------------------------------•--------------------- ------------ Alterations and/or recommendations:--_______..._ ___ ___-------------- ----------•--- --- --- 'r '�`-- .--/l.rl�s � ,..__ -� 'L. 1 1.---------- ---)--:--- •-I--------------- -------------------------- --- ••---"-------- II :4140---- -�---------C .< -.._`_.. . . __ f� ---- --(/-•------------- ---------------------------- ------- /Y .. _______________________________________________________________________________________ l ---------- -----• .-3-- � -- - �-•-- --------------------- TION ---•-- ------- # TION BY: Date_ FINAL INSPECSAN JOAQUI N1OCALWEA_UH DISTRICT 300 Wast flak Strout 144 Sycamore Street 405 Wast 91h Street 130 South American Street Tracy,California 5tackton,California Lodi,California hAantaea,California ES 9 REVISED 5-59 2M 5-62 ATLAS t