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FOROFFICE USE: -------------------------------- -- - - - - --- ''// �/ __ APPLICATION FOR SANITATION PERMIT Permit No. ... .7a - ---------------- --------------------------------------- (Complete in Duplicate) � Date Issued .._._..�.�_._.. ----------------------------------------------------- -- a This Permit Expires 1 Year From Date Issued ! Application is hereby made to the Son Joaquin Local Health District for a permit to construct anA install the work herein descrbed. This application is made in compli�apnce with County Ordinance No. 544. A-//0; 243. 2&c—0 JOB ADDRESS ANDjLOCATION. 0....... Owner's Name_...._' _.. � `.^� .........._..._ ..A------- ............................................ Phone.................................... Address.-----------�,..1-��1-•-- • -----••--.. Contractor's Name_--------- • .... --- ------`' ----------------------...................................... Phone................................... Installation will server Residence Apartment House ❑ Commercial 'El *Trailggr Court ❑ M t I ❑ Other ❑ �ffY- ti t Number of living units: (..... Number of bedrooms 2j- Numb r of baths'1__�ot"size:..__ __________________________________________ Water Supply: Public system ❑ Community system Privat Depth to Water Table ft:+#.; Character of soil to a depth of 3 feet: Sand ❑ Gra vel E]-.Sandy, � Clay ElAdobe E] Hardpan❑. -T Previous Application Made: (if yes,date-------------------- No 9 New Construction: Yes ` No E] VVA: Y ❑FHA/ es No . ,� TYPE OF INSTALLATION,:AND SPECIFICATIONS: (No septic tank or cesspool permi ed if pu 'c sewer is available within 200 feet.) Se i Tank: Distance from nearer we _______________I Dista e r foundation__-�_-�....._..Mat ria--------.............................. .....__. ... �! No. of compartments----- ..........t__�5 _Ty ---� ..---,---Liquid eptly-------�'1�'!----------C'ta� Disposal Field: Distance from near t well. . tante fram�f and tion__ Di a to nearest lot I' __ _..... y_---- Number of lines____ ____________ __________ _ Length of each7lin� _-- ........... of trench. rr Type of filter materialepth of filter.material.___.1__ ___________Total length____ iL ___-�._--_-_-__-__-___---- e Seepage Pit: Distance to nearest well--------------_-------Distance from foundation....................Distance to nearest lot line_................ ❑ Number of pits----.-......•--•------Lining material--------------------- Diameter_._...__------------__.Depthl--------.---------.-----------• d Cesspool: Distance from nearest well_________________Distance,from,foundation_,,_._____________.Lining material___.__i.......................... m ❑ Size: Diameter -----------------------------------Depth.-.-- -- ---- ---------- ----Liquid Capacity. •---•-•-------•-- -.gals._ 1 Y �,.. ._. •. - Privy: Distance,from nearest well_ ------------------- .___.____ ....__-TDEstance from nearest building--------------------._________.__.____.__. ~ ❑ Distance to nearest lot line.-----------• --•-------------- ---------------- --------------------------------------...----••---------------------------------- 1 - Remodeling and/or repairing (describe)--'-------------------------------------------------- ---------- ---•----------------------------------------------------- ----- ---•---•--••----•----------• - -----------------------•-----•--------�`'�-------------------------------••-------....--•------------------------------------------------ --------••---------••-----•-•------------------•`-------------•----------------------------------------------........-•---•------------------------------------`•----•-••----•-••----.._............--------•-••......--- -------------------------------------------------•----•------ �= t"`L".:- _.:. --------------------••----------•-•----- ---------• - I hereby certify that I have prepared this application and that the work will be done in acco dance with San`Joaquin County F ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. p rINC- _ . (Signed) -_ ------ -- --------` `"'-=------ ' (Owner and/or Contractor) howtn a of lo} system ( �---------------------------- •--•---- Plot Ian, location of s stem in relation to s, buildin s, etc., can bele laced o ' ( p 9 Y g.,yam-■,..WIG..._ p .— � reverse side). FOR DEPA MENT USE ONLY APPLICATION ACCEPTED BY---- ------------------------- -'"sy--:___ - -__ DATE----------I--------.--------------------------------------- REVIEWEDBY------------------------------------------------------------------- -- - ------- �'""'""„w'" ...............1DATE:_"r`' . • •-- BUILDING PERMIT ISSUED-------------------------•--- .... ---- ... .. . ---------------'------DATE-�"i '"r" �'.. - Alterations and/or recommendations: -----_------------- ---- --=--- ---- . ------•----------_-- I...---- ------•-•----•......---------------•-----•-•- - - 0 ..... i� ------------------------------------------------------------•------•----- ----•----.......-----.t. � --•------------ __z� ................................................. ------------------------ --- ---------•...................... v. FINAL INSPECTION BY:_ .F_ ------ Date-----��_�#--"`��_f lsie,o�. -� --._.._:. •4 � 2:r+ C7 - SAN JOAQUIN LOCAL HEALTH DISTRICT l� 4 LI 130 South American Street 300 West Oak Street 124 Sycamore Street 205 west 9t Streetrn =_x Stockton,California Lodi,California ManteCa,California Tracy,'C if rnia �'.»,m• EB 9 REYfSEo B•89 pM 3•51 ATLAS t 7 ..