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rUKt.A-r-lL7. U t: ------------ - ------------------------------- APPLICATION FOR SANITATION P!E"RMIT Permit No. ..�.�%�.��. (Complete in Duplicated -------------- --------- --- This Permit Expires 1 Year From Date Issued Date issued _ :__.1.... .`_..f j b- I 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 aCATION-----------.'�/ 'r-`j- _-_•--_ (�I / .......................................................................... Owner's Name------------ 4�. 4 ---------------------------•-•--------------•----.....__ Phone--- Address _Y_. a€ `f.. -------------------------------•---------------•------------ --------•----- Contractor's Name............--�-I -F------••---------- •---- Installation will serve: Residence C1Apartment House ❑' Commercial Trailer-Court ElMMotel ❑ Other CE( lt4 -l. d Cc Number of. units: .___T-- Number of bedrooms -------- Number of 1 -- 2-- Lot size -------- Cj r , Water Supply: Public system ❑ Community system ❑ Private CK Depth to Water Table _ ft. ` f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ •Clay ❑ e Adobe Hardpan ❑ Previous Application Made: llf yes,date-------------------- No o New Construction: Yes p No ❑ FHA/VA: Yes ❑ No,& � TYPE OF INSTALLATION AND SPECIFICATIONS:, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-4 Distance from foundation---jQ-�:.-_--.Material____ _ No. of com artments_ ` � - p Size �f � L�qurd depth -r --Capacity.A. --. ono Disposal Field, Distance from nearest well,:?0/---Distance from foundation___•., � Distance to nearest,lot line Number of lines----------------------f----------Length of each line-----.------ -ft_-��-:.Width of french-------••-•- r----•-------..._ Type of filter material._.__ e,,A'--_-.Depth of filter material..._____ Total len th_____________ lC�_-___-_---•-_-• yP p 9_ Seepage Pit: Distance to nearest well_____ J2' Distance fro ':foundation..._- --- to nearest lot line___--.i:A�-Q-r Number of pits-------------1-----.Lining material.----.' 5 -Size: Diameter-_.----33.f------Depth-------------S_---------. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining ' material___1� 17 Size: Diameter. DepthC ----- -` -------••-•---- --------------------------------------------- uid a Capacity --•......gals. Privy: Distance from nearest well-------------------------------------------------Distance from:nearest building:--•-•-•---..-.-•------------------------ 11 Disiance to nearest lot line_____________________________ __ Remodeling and/or repairing (describe)_______________________________ ------------------•--------------••--------•------- ---------I------•------------------------------•-------• ---------------------------------------•--------•----•-------------------------•---------•--------------------------------.------------------------------- hereby certify that [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. (Signed). '1 ` � -----... --... ----- ------.(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 BYor --------------------- DATE My�� c11 �_ I REVIEWEDBY-------------------------------------------------------------------- ---------- - --------- . DATE--------•-------- .... BUILDING PERMIT ISSUED-------------------------------------------------------------- -------..__ DATE--------------------------- --------- Alterations and/or recommendations_-------------- --------------------- ..__---.._ 7 -- •------------•---------------------------------------- - rlr •------ ---- - -----: --------------------•--- FINAL INSPECTION BY:_-_--_... � �----------•--------• Date--------------------•�� _ �• r ----. . _ p 74 eP oPYr Grp ualle� SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Steel 300 Wept Oak Street 124 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 0-39 YM 3-6[ ATLAS