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FOR10FFI SE: 6 ----------------------------------. APPLICATION FOR SANITATION PERMIT Permit No. l_-`-------7`-_„ ------------------ ------------------------------ (Complete in Duplicate) �/ ------- This Permit Expires 1 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 Coui,/Oinan��`'o. 549. ,� X1 t/ G JOB ADDRESS AND L CATION ------------ ./--------- �--------------------- •-•-----..__.-.....----------------------------------------------------•------------ Owner's Name_-•------- ' •: J --------- -------- `-=��• �...-------------------------------------------------- Phone.................................... Address__.__._.__-_ � -------------- ----�--}----_---------- ................ Contractor's Name _ G�� - D�_/.�,C:�� ...V---,-.7 -•-------•�-4••---•-------------------- Phone_. Installation will serve: Residence A rtment House ❑ Commercial ❑ Trailer Court ❑ Mote! Q Other ❑ Number of living units: - Vu`mber of bedrooms , ,� Number of baths ._.____ Lot size __.-~_. _ ..__ .. ,. ___..._ Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ Previous Application Made: (If yes,date----- ---------_) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S •tic Distance from nearest well_________________Distance from foundation--------------------Material---------------------------------------.......... No. of compartments-------------------------.Size-------•-------------.......,...Liquid depth------•-••----------------Capacity-- �! f 13• 'osaf .el� Distance from neargst well_-�-h:�'.._Distance from foundation..l�_�_._.Distance to nearest lot f�f Number of lines_..._:______ _l Length of each line______ `-_`__._.Width of trench__-�X� _____________� -f Type of filter material ) Depth of filter material___ �f 7 r YP P -- otal length------- -•�-�...- -, See a e Pit: Distance to neares wellL fl € Distance from oundation____ ___..Distance to nearest lot line-___-_ ------- Number �_: 9 Number of pits--- Lining material-_ D ___.-Size: Diameter. - �....Depth �..�___....._. Cesspool: Distance from nearest well-----------------Distance from foundation.-._-----------.---.Lining material-------------------------............ ❑ Size: Diameter-------------------------------------Depth---•------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building-__...-.____________.___.-.---_--_.____-. ❑ Distance to nearest lot line-------------------------------- --------------------------------------------------------••----....------------------•.---_----------------- Remodeling and/or repairing (describe): ��-- s Q�� ' \ -------- ........................ f ------ ------------------------------------------------------------ J -- _) (L (".�--..�- '- - - ------- ----- ----------------- ---- --------- ----------•--------•------------------------------------•----------------- ------------------------------------ ------------------•------------------------ --------------------------------------------------------------------------••--•------------- I hereby rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a ��I,,,,and rules and regulafwns aft San au'n Local Health District. (Si9 � ��-� {` l-G�-f- -- ----------- -Contractor) B'Y:----------------•-• Cl {Title} --------------- ---- ---- ---- -- --- "-- ---- - --- ---------------------._..._----------- --------- (Plot plan, showing size of lot, location of sys em in r ation to wells, building etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- = --- ---•------------------------------ •---- DATE-.--'P ._.'• -------------- REVIEWEDBY------------- ----------------------------- -------------------- -------------------------------------------- •-----•------- DATE-------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------- •---_----------- DATE------------------------------------------------------------- Alterations and/or recomm datigns-------------- .-- --- - r .........i-- -----•------- -----_-- -- FINAL INSPECTION BY.. - Date-------- �-----(03 - ---- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California £S 9 REVISED 8.59 2M 5-152 ATLAS