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- - - -- - -------- APPLICATION FOR SANITATION PERMIT Permit No. _.. ------- ------ - - - - -----.----. -- - ---- (Complete in Duplicate) /1 �zi This permit Expires 1 Year From Date Issued Date Issued _ f---.-.--_-- 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. L JOB ADDRESS AND LOCATION-----K-1- r_._ ---------------- -------------- -----------------------_---------- Owners Name_---Ya.2_'--k`t.kAp------------------------------------- ---------------------------------------------_ Phone----------------------- L Address--A-1` 10 2n,-vq 9 e64�____ --- -------------------------'-------------------'------------------'-----------_---'--------- �� \✓ Contractor's Name------- -�_-----�-'--T S-f--------�--------------------------------------`-'------------._-- Phone__.........-.....-.......--- Installation will serve: Residence [!r'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __. .. Number of bedrooms __t Number of baths _1.._ Lot size __.1_r_4_CC�. _-...___-__-_--__-.-___-_ Water Supply: Public system ❑ Community system ❑ Private Er Depth To Water Table ---_--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy 'Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Preyious Application Made: (if yes,date..__ --------- ---I No ®' New Construction: Yes [j--No ❑ FHA/VA: Yes ❑ Noe- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) lrrt Septic t ' a(,k: �f-Distance from nearest well-----.--_-__-_-Distance from foundation____--________.-_Material___.__-___...--.__-__...___._-.._----- 41� o. of compartments.----------------------.Size---------_----_-.__._.,_...-Liquid depth--------------------------Capacity___-___---_..--- Dislaosa},Field: stance from nearest well Distance from foundation----.__.____ - _ ___ Distance to nearest lot line_-__._.___ ... V �" ,p_A Number of lines__________________-._.----__Length of each line----_.______.-._..-.__-Width of french_--_--__--___-_-_____-_.____.___- (((//)ttt/__ / Type of filter material-______ ------------Depth of filter material---__._---__-_-___Total length-----.-_--_....__-._.-._--_..___-.. Seepage Pit: Distance to nearest well-_ t.0.-_._.-___..Distance from foundation--- 4___-.__..Distance to nearest lot line---`-5---_---_ Number of pits._ -_.Lining materiaL.C./:.__Size: Diameter------- _< ----------Depth___;2 ti-----__.--__-- (� Cesspool: Distance from nearest well_...............Distance from foundation-------------------Lining material_.----------------- ---- -.---_ �u ❑ Size: Diameter.---------------------------------Depth-----------.-----------------------------------.....Liquid Capacity_------------------------gals. C Privy: Distance from nearest well-----------------------------___--------------Distance from nearest building..--------__.------__.__-.._.--. ❑ Distance to nearest lot line---------------------------------------`-----------'---------------------------------------------- ' i L Remodeling and/or repairing (describe):--------------------- -------------------------------------------------------- ----------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------.....----------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- L - -- - ------------------- -- --------------- ---------------- -------------------------------------- ---------------------------------------------------------------- I hereby certify that 1 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, be, (Signed)------------------------------------------- --------- ----------------- ------------------------------------ -------- -{Owner and/or Contractor) rr BY=------------------------------------------------------------------------------------- - - ---------(Title)------------------------------------------ --------- -- 's L (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 LAPPLICATION ACCEPTED BY -- - - -------------------- DATE- -L' -------- REVIEWEDBY--------------------------------------- ----------------------------------------------------------------- DATE-----------------------------_-.------------------- BUILDING PERMIT ISSUED----.------------------------------- ------------._---------------------------------- DATE__---------------------------- - - --- AlFeretions and/or recomm dations---------------` _._.r._------- ---------- _ _ ------ - -- L -------------------------------- ---------- .-------------------------------------------------------•------ - � - -------0- --- ----------- FINAL INSPECTION BY:._�_r.)SAN - -- _--__---.--._....- Date.... __— "� L JOAQUIN LOCAL HEALTH DISTRICT 130 South Arnvican street 300 Wut Oak STrwt 124 Sycamore Stmt 205 West 9th Strut Storkton,California Lodi,Catifornla Manl"o,California Tracy,California 1110 ES 9 REVISED 9.59 2M 5-62 ATLAS