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- I FOR OFFICE USE: N ............1 ....:'........................... .,, APPLICATION FOR SANITATION PERMIT Permit No. . ......................................................... (Complete in Duplicate) ...................................... This Permit Expires 1 Year From Date Issued Date Issued 1_ .`.::....::..... Ipplicntion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work in described. This application is made in compliance with County Ordinance No. 519. W JOB ADOR1=55 AND LOCATION ........... ..). .,• f ,,3 j V Owner's Name........!�.e��..t. rr. .Ala_�/ ..... '. } Phone,................................... Address.._._+-._.�"� ...i— ._.i _.._.. ..�..Y..�....................._ Contractors Name.. 1 .ftp !!ti._... i '.ri._ --_.......`. ,.. _... �'}`Da......... - ....-_.... r•fV.•r r g Installation will serve: Residence eAparfinent House M Commercial ❑I Trailer Court C ) Motel Q Other n f i r Number of living units . -i�N.�u6iiser of bedrooms ..Z—. N umber obaflu .. Lot size ... e �:Z --_:._.__..._.__•--.--- Water Supply: Publi 'systern*[I"C�omMuni" Sys m � Private epth To Water Table !s—ft. Character of soil to a depth of 2 feet: Sand ��ravel® Sandy Loam lay Loam Q OaYCI Adobe❑ Hardpan O Previous Application Mede: (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 sea er is availab a within 200 feet.) Se tic;)-nk: Distance from nearest we'll,. ......Distance from foIndation_.. Ma a ial....�!?�'.��i��....._.. p .._. .. } QNa. of compartments.. ,...,.....Size-.��.. Li uid depth.....:L .............Capacit'I-_.. ... Disposal Field- Distance from-nearer#well°' ...-.-..._Distance from foundation,-_1.V......_-Distance to nearest lot l na....,' ........ -Number-t"Ines_....... ......................Le'*ngth of each line........ O-. .. Width of trench,-...�. 3!�__.r..._,........._.. Type of filter material...�_i'��,�_.Depth of filter material..*"11'_............Total length..............7........................ Seepage Pit: Distance to nearest III---.............D stance from folldn"'_- ndati .........-Distance to nearest lot line..........-...... 11 4 Number f pits.......... Lining material.................. ...Size: Diameter....•-...-.--..........Depth................__............_. Cesspool: 0istan�ce r neare t well..._.._...._....D�stance from foundation .... __. h-...Lining material......»........ .»... ..........• [J S,xe: In fe"................. Depth..............._A. . ....Liquid Capacity......... --i Privy: Distance from nearest well_......».._......... �........................ Distance fam nearest building..........._.............._.......... Distance to nearest lo+ line..._.._.».... -... .. .........•---_....-.........._._......---._ ............. Remodeling and/or repairing (describe): ...-».... ............. ... I.........._...._................•...—--..__...............I....... .l.. ._.__ .._ . ... _ ............................. ..........................a._._ .t.. ..._._.. '.__..__.._ .:...._._._. .._!._. :. ....».._.__.....,..._...._.........-.,. I hereby certify that 1 have prepared this application tha' the work will b donr in accordance w San Joaquin County ordin,anr s,"S afm lavjs, and rules an regula ons of the San Joa�in Laud Health''Dl iet. (Signed+... c :' '...... ....... .... :_.....n»._....._.. ........ .....................(Owner and/or Contractor) . _._......_.. "!n...........- _� ��,, .([itle)...................................._.......................... (Plot plan. showing size of lot, location of system in relation to wall/, build+g%, to c��can be placed on reverse side). FOR DEPARTMENT USEfONLY APPLICATION ACCEPTED BY.......-..17R.to,. •-•-• ._...._...._._...... -------............. DATE..._... REVIEWEDBY................... ............................................... ' ......................_..)....................... DATE._.................................»»..................... . SUILCING,PERMITwISSU ATE�r-:ate.�7...-----•-------_.__.... _...._.. ».»» Atteratians and/or recommendations-,..................... Y e _..-.....�s ...�.:��.� .....^r.>..-......................»»»... _,»......_.»... ... L2FINAL iNSPECTI 6& Date........ ..... SAN JOAQUIN LOCAL HEALTH DISTRICT 134D South Amrrican Stmel 300 West Oak Street 124 sycamore Strew 705 Woo 9,*sheet Stockton,callfarnia loll,California man»ca,callhmio Tracy,callfornia ES 9 REVISED 5-59 21.t 5-6: ATLAS