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FOR OFFICE USE: ice" 93 --------------------------------- -------- ----------------------- l ----------------------- ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..... ._ (Complete in Duplicate) Date Issued -----------------_-----------------____________ This Permit Expires 1 Year From Date Issued 11 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. 4ATHR PAX- JOB ADDRESS ND LOCATION.�_l "--#j�----------1_�� ---SII _. ----- •-----•--... .f..--- � 1-P -_.....-_ Q � '------------------------------------ - ------ Phone-----...=----.-.:.---••----.......-. Owner's Neme...__ - DD �-------"•-----&T;- Tm_p------------------ Contractor's N me__.__.V_lf�..A ----------- -------------------------------------------- :Pho1e......... Installation Willie e: R3siden a' Apo tment HoiSse`[ '"""C r of eici�°�❑ TTeif'e'rCo"tir•t'0" �tel*[] Other ❑ Number of living units: _ ___ _ Number of aths -.___: Lot size _____ - Q ------- umber oaf bed�r�ooms Water Supply: Public system Community sysem El! Private El Depth To Water Table _ - f#. I Loam Cla Adobe Hard an ❑ Character of soil to a depth of 3 feet: SandGra�v�el ❑ Sandy Loam �C ay ❑ y ❑ ❑ Previous Application Made: {If yes,date______----______ New Construction: Yes �No ❑ FHA/VA: YesNo ❑ r� j TYPE,OF,:INSTALLATION-TYPE, — (No septic tank or cesspool permitted if public erVir is available within 200 feet.) SepticTank:" Distance from nearest well i Distance from foundation.-./O_.__--_--Mate rial___C...t N �--.. No. of compartments___.__---- --Size...0---�C_I�_ --X SLiquid clepth____ ov �� -".___ apacity...L Q_ -_.- Dis ------ Disposal Field: Distance from nearest well Kbistance from foundation../99......___Distance to nearest lot line__ p `--- Number of lines___•..-�`---I- ----1-Length of each line__®__d-�'� � i n` ��;------"--- © !® Type of filter material._-__-___r__r�-�__ __Depth of filter material____. ____'___.__Total length___..... ___ Seepage Pit; Distance to nearest well------------- __Distance from foundation........___________.Distance to narest lot line----------------- ❑' Number of pits---- -------Lin ng material-----------------------Size: Diameter_--------------------.Depth------------- ----------- ..... pDistance -- on---------- -----.Lining materiel) ---- -- Cesspool: D e: Diameter nearest well----------------Depthce from foundation ...Liquid Capacity----------------------------gals. Privy: Distance from ne rest well-______._ = -- ---- Distance from nearest building_____.."-""_______________________________ ❑ Distance to neare f lot line--------- = ----------------------- ------------------------------"--------------•-------------------- s.�A Remodelingand/or repairing (describ ):------ ------------------------------------------------------------------------------JI----------- ---------------•-•-•--•----------------------------•---- -•--------------------------•---------------•------------------.1.....--------------------------------------------------------------------------------------------------------------------------- --"----------------- -----------••-•--------------------------------------•--._....------- -----------•-------- :--------------------------------------- -----------------------------•-----------------------•---------- --------------------------------------------------•---------•-------•------------------- --------•----------------•---------------------------------------- I hereby certify that I have prepired this application and that the work will be done tin accordance with San Joaquin County ordinances, State laws, and rules and tregulations-df-th-o*ami"'JaWgain*LataImHgMtMigtncca (Signed}--�(..rl'. .... '- -----------n---------------------------•--------- {Owner and/or Contractor) T BY:---------------•-_ --------------------••----------- ------------------------------- tt - (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 4T {�,,F,OR.jDEPaARTMENT USE ONLY p APPLICATION ACCEPTED BY �1_R-,a!--------- ------------------ ---------------------------------------- DATE------ �✓ REVIEWED BY :.� =----- ---------- BUILDINCG 1?ERMIT,ISSUED.... ----------------------------- Df47--------- ------ --------------•----------- ------------ Alterations and/or recommendations;:4- - =. --,---"--------------"--------_--- --•-------- -"----•"-------------- , s Kt` . (_Al �I '-�------------------ ',. - .......... ------------------------------------------------------------- ------------ ---- --------------------------------------------------------------------- ------ ------------------------------------- ------------- Date ------ FINAL IN TION Date-------------- V VK�--- - F SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street }��. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' Stockton,California Lodi,California sx Manteca,California Tracy,California E5 9 REVISED B•59 2M 9-62 ATLAS