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FOR FFICE --N- ` r -- 7 ------------ --------- *_____.__ ..___----___-______. PLICATION FOR SANITATION PERMIT Permit No. .�:�1-�� -------------------------- ----------------------------- (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 County Ordinance No. 549.":? JOB ADDRESS AN LOCATION.V,.,�K'_ -g +' ----"""-"--0? . : -------- �---•--- Owner's Name----- �. - hone__..f=NY, " Address...............JLS...�W _ _ _�---- :-�G c Contractor's Name...--' �S42 r •�� -�-:-_--- :.._.__ Phone-.�= Installa+ion will serve: Residenc Apartent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._.... Number of bedrooms __!Z Number of baths .1... Lot size ___64- - O Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table _Qft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe eHardpan ❑ Previous Application Made: {If yes,date--------------------I 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 fee+.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------........ .._____.._______. ❑ No. of compartments-- ----------------------Size----.....--------------••-------Liquid depth----------- --------------Capacity---------------------- Disposal Field: Distance from nearest well Distance from foundation____(4'________-Distance to nearest lot line-___S____..._. [! Number of lines------___/_______________/_� Length of each line________P2__�-------..Width of trench___ .-�________________________ Type of filter material--�T-.-------Depth of filter material---/Yk ________Total length_.../_0 6__ Seepage Pit: Distance to nearest well__---_-_______-____Distance from foundation....................Distance to nearest lot line ❑ Number of pits--------------------------Lining material-----------------------Size:' Diameter-------------- Depth-----------------..._._-•----_--- Cesspool: Distance from nearest well--________---._.Distance from foundation----------- -_-.Lining material_________________________-.________ � J ❑ Size: Diameter---=-----------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------- -------------Distance from nearest building---------------:.---•--------------------. ❑ Distance to nearest lot line----•---------------------- -rhe a ng or 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, a )rules and regulations of the San Joaquin Local Health District. / ------ ----- ----------------------------•--------------•-------------------------- r-e (Signed) nd/or Contractor) BY= -------------- (Title)-------------- (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----------------------------------------------------------- DATE_.- REVIEWEDBY----------_------------------- ----------------------------------------------------------------------------------'---------- DATE BUILDING PERMIT ISSUED---------------------------------------- ---------------------- --------- DATE Alterations and/or recommendations:_---__ - ---- ---- -- - -- -"--"/_- - ------------------------------------ -------------------•----------------------- -----------------------•-------------------------------- ---------------------------------------------------------------------------------------------------- Z FINAL INSPECTION BY:A/ -- - ----------- Date - 1 --,�---------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stmt 134 Sycamore Strout 205 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS