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FOR OFFICE USE: Permit No. ....1�-- — 7fc APPLICATION FOR SANITATION PERMIT ----------------------- ---------= (Complete in Duplicate) Date Issued ...Z .+� - : This Permit Expires i Year From Date Issue 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 ith=County Ordinance No. 549. JOB ADDRESS AND LOCATIONZ..C..-7J`f------ - ---•- •--"-"-""-. .._ _.._ 2 ---------- Phone Owner's Name----- ------ Address c �{y/ ------------S..... ..... ... •--•......---• Contractor's Name...... --••----- -._- ................................. Phone .�. --- Installation will serve: Residence _,:Apartment Htuse ElCommercial E] Trailer Court ❑ Motel ❑ Other ❑ ` x Number of living units: _.. __. Number df-bed'room's Number of baths -/---- Lot size ...... ...... . •!- Water Supply: Public system Community system ❑+w.Priva+e F1 Depth to Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ .Clay Loam ❑ Clay ❑- Adobe Hardpan ❑ Previous Application Made: (if yes,d ................."---1 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.) ] _Distance from foundation._/L2__..____..Material _ t -••---•• Septic Tank: Distance from nearest well__ r Cb aci G No. of compartments--__ Size y,Liquid de=-t.: -------------- P t ...--___-•-• ..-• rce96 Distance to nearest lot liine__,10_........ Disposal Field: Distance from nearest well-?_k Dist77�6undation____ Q Number of lines------------ ---Length of ea4hlin€=f_---.�`f------•.- Width of trench._a --•-------•-.-----••----- .m ._._. yrs ^�"" Type of filter materia�,� 1 :Depth of +a -Total matenal______.I"�"_-" -Total length------- r'9............................ _ T — = \, Seepage Pit: Distance to nearest wellelt o-r44.—.Distance from fou dation-'_.../o--------.Distance to nearest lot line.... V �- Linin materi Size: Diameter__�'3__._..-----.Depth____. ---------------••- Number of pits----- ""----- 9 ing Cesspool: Distance from nearest well_________________Distance from foundation___._.-------------- Liming mamaterial gals,, ❑ Size: Diameter------------ ----------------------Depth-------------------•- ---------------------------- q - Capacity --- 1 Privy: Distance from nearest.well--------------------•----------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-------- ---------------•--------••--•------------•---•--------••-------------.-----._...-------"----------- Remodeling and/o, 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, and rules and regulations of the San Joaquin Local Health District. k ----------------------------------- (Owner and/or Contractor] ( nedSi .9 By: -----•--... (Title)-••---------------- ---•-------------•------------------------- k (Plot plant, showing size of lot, Iota+ion of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY. _ s----- -- --------- I REVIEWED BY--------•------------------- DATE --------------- BUILDING PERMIT ISSUED----------- ----------------------------------------------------_------------------ D AeT E•----------•----------------- --------- - --- Alterations and/or repomme ations:__ _ 7- - —•--- --- `4�'" `� "` s"` +� =.1— ___________________________________________________________"..-___-. _________________________ ------ _____ __________ -_.--_ ' FINAL INSPECTION BY:.. Z 1�'---- Date------------------- 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street EStockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-89 2M 5-61 ATLAS ' �, r