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.._:`��-r................. APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------- -- (Complete in Duplicate) //l - -------------------------- ------------------ --- This Permit Expires 1 Year From Date Issued Date Issued ....... 7-.( 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 AND LOCATION... . .............. ....cvt,L.•-.• il- o'�___ ....... Owner's Name__.• !_�_ '�-! Fr�i�C Wit= l= ^..__ Phone....................................Address---.....---- �'`- ------- --- ------------------••-•--• ........................................................... Contractor's Name s.�..,.�-S•. .. Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: Number of bedrooms JP--- Number of baths _10... Lot size ----`_1_11__^.._ .................................. ................. \ Water Supply: Public system ❑ Community system ❑ Private Eg"bepth To Water Table . 0_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [[Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_______________ ____) No E-1, New Construction: Yes El"'No ❑ FHA/VA: Yes ❑ No ®'V� TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (� Septic Tank: Distance from nearest well ---------Distance from foundation__k/............Material--- _'. esad _. / No. of compartments....... -------------Size....0�?s.__.eU........Liquid depth.....I...................Capacity .Z Disposal Field: Distance from nearest well.-5_c_-------Distance from foundation..../P__ -------Distance to..nearest lot line..-,5— ....... [� Number of lines--------.3-----------------------Length of each line....7.s"'..................Width of trench----- ._........L Type of filter ............Depth of filter material..ld_.'_____________Total length_.__ '._ _._.. Seepage Pit: Distance to nearest well .��_.........Distance om foundation__�O............Distance to nearest lot line_-�.._"...._ Number of Its_... _ ......Lining material..... 6G� Size: Diameter----33............Depth........a.LF--"I...___._.... 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):.......................................................................................................................................................... -•------•----------•-----•---•-----•-•--•------•-••--•-------•--••------------------•---...-----------......_..-•---•--••--•---••-•-•----•----------•--.--.---.----------------••----•--•---------•-•----•---------------••-- -•...................•---••--------••--•--------••-•--•-------•--•--•----------•----------------------------------------•-------•---......--•---•--•-------------........._......---••-----•----•----••--._...---•-•-•----... -••----•-----•--...-----•---------------------------•-•Agula --•------ --••-•----•---•--••------•---------•--•---•-----•••-•---------•••-•----••------•--•-•---•-•-----------•---...---------------------------- I hereby certify that I havehis pplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rulea - ns of the an Joaquin Local Health District. (Signed)--------•---•------------------------•- -- --- ----- ---------------------------•--•--•--•---.----•-----------------------...-------• (Owner and/or Contractor) By:--------•-------------•----•-••------ --------------------------------------------------,••(Title)..................................................... ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can,be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYA-,._-- -- Y►'` DATE 7/�' � r . • ••----------------------- • -•----------. REVIEWEDBY -------------------------........................................................... DATE........................................................... BUILDING PERMIT ISSUED______________________________________________________________ DATE... Alterations and/or recommend'ations:............ fi.__ ---•----....--•---•--•----•----•------------------------•-•-•-------•--•---•-------•....----•-•------------...----•.....---•••---................--•--.........__.._...-----..._....---..._....•-----------------•...__....... --------------------------------------------------------- ..-------•------..._..--•--------•--••••-•.......-------•----...........--------•---------••-•-.........••-•-•---•-.._..•-•-•--•--.._...---••-•---------••-------.-- --....------••----•---•--------------------------------•---•------•-•--•- .......................... •--•------------•-•-----••---...--------•---......................-•---•-•-•--•--.....-•-------.........------•-----.... ----------••-•-•...............................................................................•---••---------.....----------•.........---.._..---•------....................:............................................... FINAL NNSPECTION BY:. `�,. G'`"`' `-...............•-----.... Date.... . `-_.. _. ......................................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stmt 300 West Oak Street 124 Sycamore Street 205 West 9th Stmt et Stockton,California Lodi,California Mont*ca,California Tracy,California u .S 9 REVISED 8.59 ZM 5-62 ATLAS