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FOR OFFI¢ USE: -pig---�- Hy 4 � /� `f.�... ._..... APPLICATION FOR SANITATION PERMIT Permit No. f -------- (Complete in Duplicate] -j-------- - ---- Date Issued ---.- _...:.-----,�.� . . .................. This Permit Expires j Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 'District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ,`E2",J J /4;W 1/17) JOB ADDRESS AND LO�ATIONIV_1,&--��'...aZ-ve!`rr-a.__ k. �� li�.J• �/c allyZ----------------------- Owner's Name--- a --- 41:4I)e-d-2_�t ------------------------------------- ------------- --------------------- ----------- ------------ Phone...............--------------------- Address-----.?j�!y.....,4_t`44//,��-a-��--A----------- -- .r` Contractor's Name------------ -------------------- ----------------•----------._- ------ Phone----------------------------------- Installation will serve: Residence [-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/--- Number of bedrooms -9_ Number of baths - --_ Lot size -_/ ---------•---------------•-----•- Water Supply: Public system ❑ Community system ❑ Private g?"IDepth To Water Table 1.7Jft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 23-'tlay ❑ Adobe 10PTiardpan ❑ Previous Application Made: [If yes,date---- ---------------I No O,"-New Construction: Yes [�No ❑ FHA/VA: Yes L;..- 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_-•'�-j�.�.._Distance from foundation___/V)___,* _------ No. of compartments...- ....Size . 20;1 X�/�'�iquid depth__-�............----Capacity. ./.� ?--.-._ Disposal Field: Distance from nearest we]..4r------Distance from foundation---le-..---.--Distance to nearest lot line. ...... Number of lines........... -._ Length of each line-- A ' _-------_..Width of trench-_,rz_/------------- ----------- Type of filter material .:j_/%c?L_t---Depth of filter material___ ----------Total length__-,l _ ____________ Seepage Pit: Distance to nearest well---.-t�� __Distance from foundation___ _ /Q__--_--.Distance to nearest lot line- ----....- Number of its._... __ ®�' p ,�------- ---Lining materiaSize: Diameter.-,_ ------------Depth-v2..7..-----------•--------- ' Cesspool: Distance from nearest well-----------------Distance from foundation... ------------....Lining material_......_---._.--..-.------------..._- ❑ Size: Diameter. - ------ ---- - -------Depth---------- --------------- --- --------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest weEl---------------------------------------- _Distance from nearest building------------------------------...__...... \ ❑ Distance to nearest lot line - ------ ---- ------------------------------------------------------ ----------------------------------------- ---------------_---------- Remodeling and/or repairing (describe):---....... - -- -------- -----•---•-------•--•----------------------- ------------ -------------------------•------------------------------------------------------------------------------------------------- ---------------------....------------------------------------------------ - - - ------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- 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, 4anddules and regulations of the San Joaquin Local Health District. FK' '.. . ........ ...(Signed} Vii-# " ---------._ r Contractor By: - '�! --------------- - -----(Title) �1� - .... . ..... ... (Plot plan, showing size of lot, location of system,,1 relation to wells, buildings, etc., can be placed on reverse side). A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY !�� 'L ---- ------------------ DATE -�-� ----------------------- REVIEWED BY----------------------------------------------------- --- DATE------------ - BUILDINGPERMIT ISSUED-------- --- - --- -- ---- ----------- ----------------------------------- --------------------- DATE--------- --------------------- ----- --------------- -- Alterations and/or recommendations:- . -----js, -----------•-- --------------------------- �.. ---------------- ---- ---------------------------------------------•------------------------------------------------------------------ ................... -- ---- ---------------- -------- - f. ---- --------------- ----,---------- --------- -------------•- ----------------- --------------------------------- --A ~P Fr- .............. f FINAL INSPECTION BY:.- ... Date......... "/ - ............. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sr»et 124 Sycamore Street 205 West 9th Street Stockton, California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS