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py rvR urrl-t ,,)k: ---- -------------- APPLICATION FOR SANITATION PERMIT Permit No. . 3.� ------ (Complete in Duplicate) ------------------ -------------------------------------- This Permit Ex ires i Year From Date Issued Date 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. 'LF-72-IS E S 9 C_i7 0^j i4-v. JOB ADDRESS AND LOCATION__;4.t--- r Owner's Name--�,.,n �4,.rrlCfl.e �f ------ ---._. Phone..---------- Address ---------- t . �l rc - ----- ---- Contractor's Name__-___ � �� - ---- •-.. Phone ..... Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-�_ ber of bedr PV"x,1golx+s��-- Number of baths ___r-- Lot size --- _-. -- -- -Water Supply: Public systemmunity system [] Private ❑ Depth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San y Loam E] Clay Loam E] y [j Adobe Hardpan C]___________________) No Le Construction: Yes No [:] � FHANA: Yes ❑ No 0 Previous Application Mede: Of yes,date 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_.___`r-----Distance from foundation----/__*4_..�_____Materiaf_.-t'e �/f No. of compartments------i?r---------------Size---4.�k-,`1--------- -----Liquid depth-- ---------Ca aci d Disposal ield: Distance from nearest well.---__`'~___.-Distance from foundation_ _1_...___-Distance to nearest lot line__. _,_..... Number of lines----- --•• --.--.________-_____Length of each line----PU",or--7,f"_Width of trenches-y_,� Type of filter material. >ra -� ./ -- -----••------ j ------_-- pfermaera _. !--•_---Total length__, "_f„--_--•-__- Seepage It: Distance to nearest well----r�-----------Distance from foundation_./A-/-----_.Distance to nearest lot line_r ..__ Number of Pits___e�__________--Lining material._YD�:I/-----_-Size: Diameter-- ► -"! Depth_- ____________ Liquid Capacity Cesspool: Distance from nearest well----------------_Distance from foundation--------------------Lining material,-------------------------- 11 Size: Diameter-----------------------•-------------Depth----------------------------------------------------Li q -------•-----------------_._---gals. Privy: Distance from nearest well-__-_____________________._______._____ _.-----Distance from nearest building-_ ❑ Distance to nearest lot line-_.______.._______________._ .- Remodeling and/or repairing (describe):------------------- ------------------------------------------------------------ ------------•-------------•-----------••-----•-•-----.- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------I----------------------------------------------------------------------------- ------..-------------•-•-------•-------- ---•---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County V I ordinances, State laws, and ddjruleess and regulations of the San Joaquin Local Health District. (Signed)-----_- '(! ----------- -------------- ----------------------------------------------------------------------------(Owner and/or Contractor) Byd-----•------------------------------------------------ Title ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - ----- DATE-•--- ._Ca-3-.. IEWED BY__.. --------------- DATE ------------------------ -•--------- UILDING PERMIT ISSUED------•--------•-------•-------- Alterations and/or recommendations:_---- -7 �1� �, l* 1�V_Za__11/2 ---------------I-- ---------------------- --------------•---------------- FINAL INSPECTION _ `//' Dte_(.-J/ _ _� ----•----------------•------- ------...... Date-SAN�d AQUIN OCAL HEALTH DISTRICT .. 130 South American Street 300 Wel+Oak Street 124 Sycamore Street 205 West 9!h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS _4r