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FOR OFFICE USE: - ---------------------------------------------- -------------------------------------------------- APPLICATION FCR SANITATION PERMIT Permit No. ..,1.._-Z. 1... (Complete in Duplicate) Date issued ........... ..1_`Z--� ---------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heaifh District for a permit to construct and install the work herein described. This application is made � u.- ,in compliance with County Ordinance No. 544. �Jr-za[o___0 L( r`/ -._ �.. d'Yuir/Ir JOB�ADDR S5 AND LOC TA ON�.E!Yr.Sr�- --DL�°f / h1 � ... Owner's Name-------- � �1(� .�.� ------------------------ ---------------------------------------------------------------- Phone..................--------------•--- Address-----;---- ?�IP,r............. - Contractor s Nanie- �� '- ��CC/, -.---....... Phone.......---.-_------••------------ Installation will serve: Residence .Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Otpher ❑ fI Number of living units: __�__ Number of bedrooms--- Number of baths j/ Lot size _Xt V-�. t�-��--•-----•--•--- Water Supply: Public system r] `Community system ❑ Private Depth to Water Table (/ft. Character of soil to a depth of 3 fee+: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------------.--- ---) No @2-New Construction: Yes �o ❑ FHA/VA: Yes 9?-'NO ❑ TYPE OF INSTALLATION AND°SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T Sceptic T nk: Distance from nearest well ._-4d�_ -___Distance frojm founld�ation,Y._ _.� No. of compartments------ --------------size __/�_- Q.- ---Liquid depth---- -----------Capacity__ f��.._--- IDisposal Field: Distance from nears well---��-__---.Distance from foundatj=`-_/e........Distance to nearest lot line..-;..- ! I Number of lines___ --- --_----_Length of each line__-(---------------------Width of trench--- : _-_-<_____----___----_-. Type of filter material --------------Depth of filter material---/t�-- -_ -----Total length-.-_` _P-------------------------- See a it: Distance to nearest well-----------------------Distance from foundation Number to nearest lot line----------------- Number of pits---- ---------------Lining material-------------- i,-------Size: Diameter------------------------Depth--------------------------------- Y 1 Cesspool: Distance from nearest well-----------------Distance from•foundation------------- ---Lining material_------_----_----__--_--_--__.---_. I] Size: Diameter---------------------- ---------------Depth---------------------------'. ----------..fL-iquid Capacity------_-----------------•gals. } privy: Distance from nearest well ---- -----:�%--:_- ----------------------------Distance from nearest building----------------------------------------- C1Distance to nearest lot line-----------------------------------------------------------•-------- ---••--•------ •------••---------_------------.---- ---------------- Remodeling 11-1 and/or repairing describe - --------------------• -- . ----••-------------------- --- -" ..-.. --------------- - - --_____4 . hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and piles and re ulatio s of the San Joaquin-Local Health District- a (Signed) `" � ................... or Contractor By:_------------------------------------------------------- ---------------- -- ------•-•••------- ------------- --- -------------- (Phot plan, showing-size of lot, location of system-in tion to wells,- buildings, etc.,-can.1:;e'-:placed-on reverse-side).- - - -= FOR DEPARTMENTUSE O LY - APPLICATION ACCEPTED BY_ - -- - -------------- ----------- DATE.- ------ Y REVIEWEDBY------------------------------------------------------------------------------- -------------------.... DATE BUILDINGPERMIT ISSUED-------------------------------------------------------------------------_-•----------------------• DATE------------------------------------------------------------- Alterationsand/or recommendations--------------------------------------------- -----••----•-----••-----------•-----•-----------•---•------•--------- ---................11- -------------- A --• ----------- a� r--�-L�i,_KA: "�I9t�� Q!`� ��*�C-�.....-------------------------------- ..-�?I-��_'_-------------•...................... .. -----•-•--I---••---•------ •------•--••------------------- -- --------------------- ------------------------------------ ---- - ------------------------- ------------•-------------------•----- --------------------------•--• ----•------------• --------------- -------------------------------------- h � FINAL INSPECTION-.B = ------- --- � - Date------ -..-'G"+"�------ ------------------ 1�. SAN JOAQUIN LOCAL HEALTH DISTRICT 1'30 South Anterictin Street 300 West Oak Street 124 Sycamori Street'! v 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ZS 9 REVISED 5-59 2101 5-61 ATLAS