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--- ------- ----- ------ ------" " 3 v APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------- -------------------------- (Complete in Duplicate) This Permit Ex ices ] Year From Date Issued Application is herebyDate Issued made to the Sen Joaquin Local Healfh 'District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_ -v j ------`�' �'�� ''----•-- .......... Owner's Name__.__W1_X{- •• � ---•----••----•------ _ Address _t9 m r) ------ Phone.H v ----- , p.T.f;. .. --•--•-----•-----••-----•-•----•-------••----••---------------•-••-•-----•-------..._ Contractor's Name_..__-__--P.,--:� Installation will serve: Residence - ---¢ nl-s__. _e, Phone---l.z!_P..�..9..4�?_..._. ® Apartment House ❑ Commercial Number of livingunits: ❑ Trailer Court [) Motel ❑ Other ❑ Number of bedrooms __z___ Number of baths ---/--- Lot size .____: -- __'"" Wafer Supply: Public system ® Clbommunity system .._X-•-.....7!p-._--_------•-------- Character of soil to a depth of 3 feat: Private ❑ Private ❑ Depth ro Water Table _.._-__ ft. I ❑ Gravel ❑ Sandy Loam ❑ Clay Loam �] Clay Previous Application Made: (If yes,date------------------- y ❑ Adobe® Hardpan 0 TYPE OF INSTALLATION AND SPECIFICATIONS: 1 No ® New Construction: Yes [] '°No ® FHANA: Yes ❑ No (No septic tank or Cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----_-----------Distance from foundation.___-__._____ ❑ No. of compartments_-___-___ -----.Material____.-_ Size_- ------------------ -------Liquid depth----------- --------------Capacity.......--•--•-----.--- Disposal Field: Distance from nearest well_lti!_p_Ng_- � Distance from founda#ion_..�v' -_ Number of lines_-_____.___/-------------- Distance to nearest lot----------------------Length Length.of each line___.__••_--moo._'-."-•--- �d� Type of filter material._.T 7 G_ Depth of filter material_________ ------------Width of trench.__.__..-.._A-y-," See a e PitTotal length----------.............-xs?_,_ \ i ❑P g Distance to nearest well-------------_-------_Distance from foundation___..__.__..___- fi Number of pits--_--_ _ _ Distance to nearest lot line------__.__ -' Lining material-----------------------Size: Diameter-" _------------------Cesspool: Distance from 'nearest well-----------_----_Distance from foundati n. e Depth-___-__.---__--___----_---- --- ❑ Size: Diameter:_-__"_-"----""_--_- --Lining material---------- ------------------------------ d -----.Depth-------------------- •------.. -----=------------------Li Liquid Capacity rivy: Distance from nearest well -------------------- -----• -------- - q P tY-- ------•---•---•--••---•--gals. ❑ Distance�fo nearest' lot line "--_---_ ------Distance from nearest building------------------------ -•--------------•-- Remodeling and/or repairing (describe : !ii-o.- p Ta- �•z--------- ;_.__.._.. ------------•-•-•-----•---•------•--•--------- ----•---] -- 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. Si ned F ------------------------------------------- ( g )-...-----•,� C-�t_:---"--�, (Owner and/or Contractor] ---• --------------------------------------------- ----------- ot plan, showing size of lot, location of system in relation to wells, buildings, etc., canbeplaced on reverse side]. I FOR DEPARTMENT USE ONLY f 7Z-- REVIEWED ED BY ACCT-PTSD BY _-k-.----------- --------�-------- ----------------------•---------------- DATE— ............... REVIEWED BY BUILDING PERMIT ISSUED--------- _ - %f� ' ------------------------ ------ DATE--- Alterations and/or recommed -- ---- --- omDATE --�f-.---:" -ons _ � . _ :. ----- -----•---L----- ! _ ---------------- ---- ' ---------- �� k ---------------------------------- ---------------.---------------------------------------------------------------------- FINAL INSPECTION BY: ` zr«' � �� f 7 ------ Date...................................— r C�� 130 South American StreetSAN JOAQUIN LOCAL HEALTH DISTRICT Stockton,California 300 West Oak Street 134 sycamore Street ILodi,California 305 West 9th Street ES 9 REVISED 8-59 2M 9- Manteeo,California 42 ATLAS Tracy,California