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--------------------•---.----------- APPLICATION FOR SANITATION PERMIT Permit No. -L`��3_j '.................. ....................... (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued. ' L 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 comp liance with County Ordinance No.A49. L JOB ADDRESS ANQ�}OCAT N...._..S_O�O G._dd �.... _� -- Owner's Name. .. Phone--------- Contractor's Name.------- . .. PhonX.1!1- .4107__ Installation will serve: Residence ®partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-- __. Number of bedrooms _a Number of baths Lot size _.. l Cd .X ..: 6 ...--....... Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table�� ft. LCharacter of soil to a depth of 3 feet: Send ❑ Gravel ❑�Sandy Loam El Clay Loam ❑ Clay ❑ Adobe�ardpen ❑ Previous Applicaf ion Made: (If yes,date....................) No gr"`New Construction: Yes ❑ No ? FHA/VA: Yes Cl No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: L (No septic tank or cesspool permitted if public sewer is available within 200 feet.) P" k;, Distance from nearest well.................Distance from foundation_..................Material..........................._.._.............. _. No. of compartments-----.------------------Size.---------,.----------- _Liquid depth-------..___--..._..----Capacity.__.._.._.-._._. Disposal d: Distance from nearest well.x_5�10_---Distance from foundation...R_S.......Distance to nearest lot lionA__..___ 6 [r� Number of lines.-..--.�... . .. __ Length of each line......R.,O._...__........Width of trench..... t� Type of filter materiaLm C - Depth of filter material....._!�_�....Total length..........._..._.._ L Seepag it: Distance to nearest well_.A/L_Q�.__...Distanc m f undation.-3Q_� Distance to nearest lot line--- Number of pits...._--..__._--_.Lining material_ 4.ZU---Size: Diameter.....3.3-' .....Depth.........7.S. ------- Cesspool: Distance from nearest well.................Distance from foundation.-------------------Lining material (� ❑ Size: Diameter--------------------------------Depth - q ..._____.___..Liquid Capacity......_... gals. Privy: Distance from nearest well_...................... ...................-'---Distance from nearest building__._.-__-------�__...-.._.Is. ❑ Distance to nearest lot line--...................................------.. -- ._...-- ----- .—. LRemodeling and/ot repairing (describe):...................-......-..........-----^___.....__._______--__--_____-------------------------•--�_._�_.___. ---------—__- -._._.._ _.:......------------- -•-------------••-----------------—----------------------------_-_----------...---......-...—..... - - -----------•-------------------------- --------•----••-------------•------------------------------•------------------------------r---------------------------•--------... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc tate laws, a rules end r guletions o -haAS/an Joaquin Local Health District- (Signed). _ i. .---- ��(?s✓ -,- --.-_� Owner end/or Contractor] --- ---- /, I ----- By:.......................---..._.............. -- - �ifle) ...._..-.--•---••- (Plot plan, showing size of lot, location f sysiS tem in relation to IIs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ..... -- - - - - --•----•--- DATE .-.. -` - REVIEWEDBY--------------------------------------------- - --------------------------•-•---------------- _ DATE..................-._.._------....._.....--------- ` BUILDING PERMIT ISSUED...................... ---------------------------•----------..............._._...------. DATE.----------•-------•- j---- ........................... -- -- - Altedr (ions and or recomm/e crati ns:__-.....--..-------- ---- ------._ . .... ,( ._..____...._. ` ---f•'•-----ro----`'------=---.-I"' .I. _..-- ,671�• ti-.:'- ---�`.f'c----- __.__...___.. . ..........---•'--•----•.................................................... L ------------------------------------------------------ _ - - -----....----_..__-•--.-----------....--•---....--------------------------.........------- FINAL INSPECTION BY:...V'/ '' - Date....... --- �---_2................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Shul 700 Weat Oak Saul 174 S,camore Street 203 Won 9a,Stroat Stockton, California Lodi,California Manteca, California Trucy,California ES 9 REVISED B-59 RM 5-61 ATLAS