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FOFFICE USE: I �f3 o d -- - Permit No. f ..../ ..._ ... -----------------iL _. 1'1{ APPLICATION FOR SANITATION PERMIT ` / ------------ ------- ------------------ ------ ------- (Complete in Duplicaf4) �I Date Issued ..... __ _ -- This Permit Expires 1 Year From Date Issued ............ . Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. lI� �n 1-------------------------- + JOB ADDRESS AND L TION------ = .G�/ { � .............••--•-•--•---••---•----- Owner s Name---------- ! . ---Q.. 7 ------ ---------------------- _.- Phone------. ----- ' r Address......................... ............. = Contractor's Name----- -- '•�,��---------- --------------------------------------------- --------- Phone----- - -------............... Installation will serve: Resident partment House Commercial ❑ Trail r Court ❑ Motel ❑ Other [:1 size .- Number of living units: __ -__ Number of bedrooms _ Number ---1�1��• --- ----.--•- - Water Supply: Public system ❑E Community system ❑ Private Water Table .4724t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San `Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ PreAous Application Made: -[if yes,dote--------------------) No New Construction: Yes . `Co ❑ FHA/VA:'Yes ❑ No i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance:from nearest well_-_I�______Distance from foundation__/�_______...Ma erial .�. rl G- ------------- No. of compartments-_77..r------------ ------Liquid dep�h____.�_ _Ie.e,_.__-------Capalcity,0.0-1 -------- Disposal t �l\ Disposal Fi d: Distance from nearest well_ 'ist /------ 9 F-- '--G— lot linea..- "v ' _� -; -------- --DLenath of each lince from ne_ to nearest,)---- ••I--�------•----•-- O Number of lines_________ __ __ � _._._Width of trench___ Type of filter material._.__. -1CC�epth of filter material___,- `--- dotal length______ _____________________________ f r1. -_r..Dista c to nearestilot line_j Seepage It: Distance to nearest well.-________-Distance from foundation_._._ Number,of pits"Z _____________Lining material__ o.G( _..Size: Diameter__ ____...___.Depth___--�____.___________- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------!..._______-----________....- ❑ Size: Diameter--------------------------------------De th----------------- •-----Li uid Ca aci �M Depth q p tY--�---------------------•-•-9als. Privy: Distance from nearest well__----------------------------------------------Distance from nearest building----------.I--------_-..-_----------.---- ❑ Distance to nearest lot line-------------•-------------------------------- -------I---------•--•-- ------------------- --------------------!!1 Remodeling and/or repairing il(describe): ______ ---------------------•------------- •---------------•----•------ .-------------------------•------------ ... ' ------•----------------------------------•--------------•---------------------------•-•-----------------------------------------------------................................................=----------•-•--------------- ` .---- ---•------•------------------------•--------------------..._------ -----------------------------•-------------------------•------•-------------------•------------------------------M-•--- ---- - v I hereby certify that 1 have prepared this application and that the work will be done in accordance with Sari Joaquin County . ordinances, 5 a e ws, and ru egulations of the Joaquin Local Health District. (Signed)------ ----------------- (Owner and/or Contractor) aBy:------------------_.. --- y` ------------------------------------(T;tlel � �✓ l (Plat plan, showing size o t location of system in relation Ings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY er .' APPLICATION ACCEPTED BY---/, ---. " ---------------------------- -I -�T �p -----•---------•------- DATE-•--�=--�--=------ ------------- REVIEWEDBY ------------------------- DATE----------------------------------•------------------------ BUILDING PERMIT ISSUED--------------------------------------------------------------- DATE----------------------- IM Alterations and/or recommendations:____-_ _ _ -. __ _ ------ ---r....r `Y �' •- '`� -�-- / 61 ��- .c �i yc T— '�-' --G.] ---�-�----� .1.--- '_`--�I lV..l. . ----------•------------•---•-------------------------------------------------------------------- -----------------------------------------------------•---•-----------------------• •----------- ---------------- ------------------------- -------------------------•---- ............------------------ Z FINAL INSPECTION BY:.____. r -I. ---.--. -.- - D to /-- ;/ 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak SrT*et 124 Sycamore Street 405 West 9th Street Stockton,Collfornla Lodi,California Manteear California Tracy,(California ES 9 REVISED 8.59 2M 5-62 ATLAS