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FOROFFICE USE: _- -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ../:. ,//.!. .' Com(Complete in Duplicate)� P P ) Date Issued .....�/Z/..__�-� ------------- This Permit Ex ires 1 Year From Date Issued 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 C Tl ___•�4_-A --_-- ----fes.- �f�� •-•-•-........ Owner's Name- _ --. ..____ Phone._TTsU.. � .....`. Address...... �,�l�`�---- .... _ �,] -------- --------------•--•-•-•-----........•-------- -......................................................•............ .. Contractor's Name ..........:----------y................. Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/--- Number of bedrooms _ _ Number of baths _-/.. Lot size ---rx .................................. Water Supply: Public system ecommunity system ❑-'Private C],,Depth to Water Table . aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel_❑ Sandy.Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: (if yes,date--------------------) No e New Construction: Yes ❑ No Ra"�FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted,if public sewer is avatleble within 20Q fee+:)—'"-` "" - Se tic Ta k:� Distance from nearest well-----------------Distance'from;foundation. ___'_'_ :_c'Material.............--.•.•........... ................ No. of compartments------------- ------------Sipe-- - ---=-------•------ •----.--.Liquid dep#h '#•` ------i-Capacity.....:................. Disposal Field: Distance from nearest well -----"�..-Distance from foundation.- -Q------.---.Distance tp nearest lot line...64. ....... gig Number of lines---------- ---I-----------------�,,Length of each line.._../ q Width of4rench. K Type of filter materia(,� � &Depth-.of filter material.----��-__----_--Total length A r.�� l .............................. Seepage Pit: Distance to nearest well------�-.-_------Dist Distance from f t�ndation-_--le.__....Distance to a rest lot line---- ----- ine---- -1.... \ , Number of pits----- -------------Lining material- � ----Size: Diameter ��.. --------Depth---j Number v Cesspool: Distance from nearest well.....=r�.isiance from foundation--------------------Lining material..................................... d F ❑ Size: Diatnet-�----'-�-�-,-,-I-'-_------------•---•-�e� ------------------------------------------------Liquid Capacity----------------------------- _ Privy: Distarice..from nearest well----------------------1-------- ------------------Distance from nearest building------------------------------------------ ❑ Distance,to nearest lot line--------------------- --------------------- -- -------•---�-•------------•-----....------•---.....-•---•--••---•----•.............•-------- Remodeling and/or repairing (describe): ------------- —=�I�Z `�� _ t _..- . , - - ---------•--••--•---•----•---•-••------•-`•-----••-•------------------------------------------------------------------------------------- ------- --- _. .�------------........................I........ ....... ........................ ..... - I + I Il I hereby certify that.I!have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an98 r les and regulations of the San Joaquin Local Health District. (Signed)---------------------- ... ( or Contractor) B •. ------ Title ll-�� '-------- -- - -------------•- ( 1 • i' (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc' can be placed on reverse side). ati FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- Y = 4: ............. --------------------------------------------- .. DATE. ,� REVIEWED BY....---------- ------- • - .",� -_. ---------�'` r ------------- DATE-- ---. ---•-----------•-----..._ . - • ----------------- --------------------- ---------------------- ------------------------ BUILDING PERMIT ISSUED--------------------- ------ � '"`---- Yom----- - -------------- DATE Alterations and/or redo mendations:-.- __._- jIf �f gib .--� ! w. •- ----------------------------- ---•----•-•----------------------------------------------- ----------------------------------------.-..... ------------•-------------------•-----------....-•-------------------------•---... FINAL INSPECTION BY:..-j.t.----- -- ' -.---------- Date.- _- -�� " S'AN.JOAQUIN LOCAL HEALTH DISTRICT .a�, 130 South American Street 300 West'OakSveet 124 Sycamore Street 205 West 91h street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED B-B9 21A 6.61 ATLAS i