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FOR OFFICE USE: .............................. ...... APPLICATION FOR SANITATION PERMIT Permit No, `•: .. ...... .....................................•••••....I....... (Complete in Duplicate) r ..•.....•.. ........ .................................. This Permit Ex fres 1 Year From Date is a Date Issued ...........1 .. o�rT--L q919- Application is hereby mads to the San Joaqui/ n Local Health District for a permit nstruc and install t work h ` This applicetion,is made, in. compliance with County Ordinance No. 549. J09 ADDRESS AND LOCATION.1-��1 �5 ...Fron...� F', ]OVA 5le Owner's Nam o 0 0 _ ............................................. t a= Phone Address ......................... ................ . ..............._....._...... .............................4L................................. I........ Contractor's Name.... s7�._.. C_Q-t�......... Phone ................................ ............... .. .... ... Installation will serve: Residence E]Apartmen House ❑ Commercial (N, Trailer Court ❑ Motel ❑ Other ❑ Number of living units:........ Number of bedrooms ........ Number of baths ........ Lot size ..............1 S..ant4._C-4 J.____. „- f Water Supply: Public system ❑ Community system ❑ Private (k Depth to Water Table ........ ft. �• Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam t Clay Loam ❑ Clay [] Adobe ❑ Hardman ❑ �r Previous Application Mede: (if yes, date .......... ......... ) No ❑ . ;New Construcfion:jYes.9 No ❑ FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f ! d . i Septic Tank: Distance from nearest well....c�'..._..._Distapn-r�et from foundation ..... I•.Q....... Mete�ol........... . ..��4.1........:, .� No. of comportments.... ................Siz :rl:�.>i.'�._--Liquid depth .... .....................Capacity.od.p.A..... ! -- Dispo�gl Field: Distance from nearest well ... LoD...Distance4rom foundation......a(..........Dlstance to nearest lot Iine..-S ......... Number 6f lines ............. Z ........ _... Length of each line......... l.S'11..........Width of trench.... A.�.............'•..._...,. Type of filter material....... . ,t�.....Depth of„filter material ..... IX. ....... Total length ....... 5�..�•..••. Seepage Pit: Distance to nearest well., .................... Disfan'ce from foundation ....... ............. Distance to nearest lot line ................. ❑ Number of pits..... ................. Lining material... ...... '-............ Size: Diameter....................... Depth ............... .................. Cesspool: Distance from nearest wall.................Distance fl° n foundation ... ................. Lining material....................... ............. Size: Diameter ....................DepthCapacity 9 P .............. .........I.......................................Li Liquid Ca i ........:.....gals. Privy: Distance from nearest well ........................ ......................... Distance from nearest building ❑ Distance to nearest lot line............................................................................. ........ l R (describe): .................. ................... . . .............................••-----•-•..,...................------------.............................. .......... ....................................................................................... _............... .............. .................... ........ .......................... .................................... ! hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinance$, .S ate laws, and ples and regulations of,tho Sen••Joiquin Local Health District. t :� ned ' r (Si,_ }..._.. L( �'4.... ..iu ....._.. ..!x' . ��..'... ........................�r Contract .. ra r) By:... _ h!dt rrv?1 ` ........... � ., ..,� -.. .(Title}.....................................................:...�... (Plot plan, showing si:o of lot, location of system in relat n fo wells, building's, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY y APPLICATION ACCEPTED . .. ............................... DATE...�'I....'._f.2..":.G ................... ,....... REVIEWED BY..........:..................................................... ..... .......................................... DATE.................................................`...... BUILDINGPERMIT ISSUED ............ ..................... ................... ........ _................. .................. DATE ................................. ............................ Alterations and/or recommendations .......................... ..... ... .. 1 .........-•..................................................................................................................................................................................................... ........................................... ................................................................................... ........................................ ................................ ............. ............................................................................................................................................................................................................. ........................................... ....... ................................................................................................................ .. //..............................._.................-- FINAL INSPECTION BY .... :..................... Date......(...��`' b Y 130 South American Street Stockton, Calltornia EO 9 REVISED 8•59 2M 5•61 ATLAS SAN JOAQUIN•LOCAL HEALTH DISTRICT., 300 W01 Oak Sirn.'t lam” 124 Sycamore Str*r1 ` 205 Wart 91h Slrnal Lodi, California Montoco, California ! Tracy, California