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FOR OFFICE USE: ,;/- ----------1,10-d------ J ------ ------------------------ ---------------- APPLICATION FOR SANITATION PERMIT Permit No. -.-/...... ...7 ------ ----------T---------------------------------------I (Complete in Duplicate) Date Issued ..... -2— - ----------------------------------------- ------------- This Permit Expires I Year From Date Issued q Application is hereby made to.,he San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in corApliance with County Or nce No. S49. JOB ADDRESS AND CATIION !'.� _. - - -- ------ ----------- ------............ ........... ....... ............ ............................. Owner's Name............ tm-,K ---------- ......---------------------------------------------- . Phone4 -Address .....------------- ............. ...I........I....... . . . ..... .. ...... — - Contractors Name -- ---- .. .. .......... . Phone .. ..... Installation will serve: Residen't'!I a Apartment House 0 Commercial [I Tral or Court [] Motel 0 Other ❑ Number of living units- Number of bedroom Number of baths .-;"-'�Lof size .16. 1- Water Supply; Public system Community system [I Private ❑ Depth to Water Table .6 ft. Character of sail to a depth of!3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam 0 Clay 0 Adobe rHardpan C3 Previous Application Made: (if;yes,date--_---___----- --- --- No ❑ Now Construction: Yes [] No 8"--FHA/VA: Yes 0 NoO TYPE IN ALLATI N6 SPECIFICATIONS: 1� septic tank or cesspool permitted if public sewer is available within 200 feet.) k-\ Distance from nearest well_________________Distance from foundation........---------Material........... 11 -�; --------....................... No. of comp'artments--------------------------Size--------------------------------Liquid depth--------------— --------Ca4pacity----------------------- sposal i I dil-— 0! Distance fro' m nearest well_________________Distance from foundation--------------------Distance to nearest lot line...._.._._....... 01E ON septic k- t spo -r sal� Id Number ofj�lines-----------------------------------Length of each line----------------------------..Width of trench----------------------------.------ Type rench---------------------------------- Type of filter material.-.---.-------------------Depth of filter material-----------------------Total length___________..-----..----..._.._.._..___._. See age Pit: Distance tol nearelt well-k-1.0-Me-----Distance ro foundation___t- ___.Distance--Distance to nearest lot Number Of-P' "Lts---- ----------------Lining material,.- _______.Size: Diameter_Jc-?5-"'--Depth-----'21 71!_ ----• Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material__.____......._.___...__.______-_-_._ `�1 ❑ aterial ............----------------------- 0 Size: Diarnker------------------------------------Depth----------------------------------------------------Liquid Capacity------------------ ---------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building___-__._-_._--_._____________.__________. ❑ Distance toi;nearest lot line---------------------------- -- -------------- ---------------------- ---------------------------- -- ------------------------- Remodeling and/or repairing [describe):---------------------------- ---------------------- ----------------------------- -- ...............I------- --- ---------------- ----------- -------------------------------------- ------- ------------- ------ - -- ------ --- --- -- ------- -- ---------- ---- --- --- -- -------- --- - - ---------- ----- ---------------------------------------------------------------------------- --- ---- -------------- ----- -- - --------- ---- ---- --- -- ---- -- ---- - ------- ----------------------------------- .................t(-................. ---------------- .. ------•..•------•--------•----------------------------•--- -----------•--.._..------------------•---------------- I ------------------------ I hereby certify that I have prepared this application and that the work will be done in acc rdance with San Joaquin County 11 ordinances, State jAws,jaruies and San Joaquin Local Health District. (Signed)......of--- - ---- -- ----- - -- --------------------------- (Title)---- -- (Plot - ----------------------------------- ----C---o--n--t-r--a--c-t---o--r-) By: 0 (rifle)---- (Plot - plan, showing size of lot, location of system in relation! w S, ngs, efc. a be placed on reverse side). t FOR DEE -TMENT USE ONLY APPLICATION ACCEPTED BY[I--- -------------------------------------------------------------- DATE----- - ----- -----......_._ REVIEWEDBY--------------- -41------------------------ ---------------------------------------........--- DATE--------------------------------------------- -11------------ --------- ------------- BUILDING PERMIT ISSUED—Al----------------------------------------------------------------------------•-------------L--- DATE------------------------ Alterations and/or recommendations: - - --------------------------------------- --- ... : el, .. ... . .......... ----- -------- ,_ _je!.e j_;teq......... , - --------- ------------ --- ----- -- ----.... . ... . -------------------------- 11........--......... ..........------------------------------------------- ----------------------------------------------------------------------... .. --------------------- ------------------------------------------- -------------------•--•----------._......----••---------------•------------- ------------------------------------------------------------------------------------------------------------------------------------------------ - ....................................... ..............---------------------------------------------------------------------------------------------------------------------------------- --------------------- FINAL INSPECTION -------------- ------ --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Svre*t 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-61 ATLAS -I-