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FOR OFFICE USE: ......................................... ............ ..•.............•....•............. APPLICATION FOR SANITATION PERMIT Permit No. ............................................I........•• (Complete in Duplicate) r `/"�/. .................. -•-•••......•• This Permit Expires 1 Year From Date ( e Date Issued ....._.....1/_�.... Application is hereby made to the San Joaquin Local Health District for o permit e nstruc nd install th work h r This applicotion•is made. in. compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION A .._........ r�.nf ..I I............................ ...._... OwnersNam .... .... 70�----1"fL-Crf`? ....... Phone...................Address.........G.._.................... ....._.................................................................. Contractor's Name.... 4............ �c4......... Phone ................................... Installation will serve: Residence ❑ Aparimen House [] Commercial I, Trailer Court ❑ Motel ❑ Other ❑ Number of living units:........ Number of bedrooms ........ Number of baths ........ Lot size•..............r'-..a'O/L-�tJ..__..:-'..... Water Supply: Public system ❑ Community system ❑ Private It Depth to Wafer Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe [❑ Hardpan ❑ Provious Application Made: (If yes,date......... .........) No D. ;New Construction:"Yes.&V No ❑ FHA/VA: Yes ❑ No ❑ J TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pormitted if public sewer is available within 204 feet.) �„ l �� F Septic Tank: Distance from nearest well:....__..._ Distenc�e}from foundation ..... %.Q....... Moerioi....�/..t,.4 � •••,;„-:• .` If , No. of compartments.....�._..............Siz �:(;�X •� Liquid depth...... .............__....Cepacity.cE� ..11.d..... p� 19 i -- i Dispel Field: Distance from nearest well... f..Q. Distance"from foundation ...... 0../.._.Distance to nearest lo` line.. .. t Number df lines............. Z .......... Length of each line......,.. �1.S!...........Width of french .................'......... 0� Type of filter material ... f!rk�tYL.....;Depth of.,filter material.. /Y"" Lang#h._....•/�S;t?.. ................. Seepage Pit: Distance to nearest well ......................Distance from foundation .................... Distance to nearest lot line ................. ElNumber of pits..... ................. Lining material ........... ............. Size: Diameter....................... Depth ........ ....................... .. Cesspool: Distance from nearest well.................Distance ffoin foundation ........... ......... Lining material ...................................... ❑' Size: Diameter. ._.Depth .:................... ..•............................ Liquid Capacity, ..................... _..gals. Privy: Distance from nearest well ................... ...................... ........Distance from nearest building ................... ❑ Distance to noarest lot line....................................................................................... I R (describe] t ..................... ............................................................................. ................. ....••••....._...................I..........................••---.......................--------......... ......•........................................................•..._.......................................----•-•----....---------.........---....... ............... ,•T I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, .S afe laws, and les and regulations of -the Sen --Joaquin Local Health District. t {Signed}..._..%rc.t'-p...!..,.. ...... ti..'......--••-•.................................................�{�QWrterTrtdrbr Contractor) fi L}� ,(� �...•......1t�, ................................................ ... �`-- •• .... .. _ _ _... (Title}............... (Plot plan, showing size of lot, location of system in relat n to wells, buildings, etc., can be placed on reverse side). } FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY_. - ..1r2..' :.... .......... REVIEWEDBY.................................................................. ... ..... ...... ..... ..,.... .._....... DATE..... .... ............. ...._.---------------......:...... BUILDINGPERMIT ISSUED .... ........................... ..................... ........ ._..... ........................ ._....... DATE ...................................... Alterations and/or rocommend'ations:......................... ................................................... . _... �....... ...............................................................................................................................................................................................................•---..._....... .•..................................... 1 ---- ..................................................... FINAL INSPECTION BY!!Z2l�X�.................... Dote......(... v......_....................- - ^ _• T SAN JOAQUIN•LUCAL HEALTH DISTRICT, ` W 130 Sovth American S1ree1 300 Whir Oak Srreet lam' 124 Sycamori Strert'205 Wed 9th 51re E1 4 Stockton, California Lodi, California Manteca, California A Tracy, California Ea 9 REVISED H•B9 2M 5•61 ATLAS