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FOR OFFICE USE. ---------------------------------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....... A ---------------------------------------------I----- ----- (Complete in Duplicate) :- - 1. 7- ' -. ' 0 - Issued ----------- --------- -----------__._._-------- This Permit Expires I'Year From Date Issued Date ............... Application is hereby miad J 0 San Joaquin Local Healfh.Disfrict fora permit.fo itonstruct and install the work herein described. This application ismadein compliance with County Ordinance No. 549: JOB ADDRESS'.AND-LOC 16-----! I- .... ................... 7 ---------------------- ............ Owner's Name----------- -- ----- Address._- ............. .. .................... J--- ----f-------- —----------------------------------- ........... ------------ Contractor's Name ... .... ........... A,. Installation will serVe:- IResi-ence E] Apa rfment,House'E] Trailer Court Motel 0 Other E] Number.'of living uni Number of bedrooms _214umber.of baths __ ____.Lot size ......... ................................... r Water Supply:. Public systemy Community system EjPrivate e to Water Table -------- ft. Character of.soil to a Qapy 3 feet- Sand F] Gravel ❑ Sandy Loam ❑ Clay Loam 'i. — " _] Clay ❑ Adobe&IHarclpan Previous Application Made: (If yes,date-------------- No New C6n struction Yes 3--Ro 0 FHANA. Yes F) No 4. �of TYPE OF INSTALLATION AND SPECIFICATIONS: :(No septic tank or c spool permitted if public sewer is available within 200 feet.) Septi Tank:Tank: "Distance from nearest well.--f. ...Distance from foundation_____)............Mat'erial------------..................................... F410. . a f 'nipa-r4ments--------------------------Size.... Liquid depth.......... Capacity./ ... Disposal Field:'- Distance frolm nearest well----47�7�_.Distance from foundation-------<?-- Distance to nearest lot line., --------------- 0 Number of lines--------------I.------------------Length of each line---- .........Width of french------ . ............. P :----------Total length____......._.9.4%�------------------- Typ'6'o'f 11ter material._.- t_be'th of material--`- Seepage Pit: Distanc to nearest weIl___1_i2 ......Distance from foundation......./....0../-......Disitpr)c/e to nearest lot line------- Numloe f'pifs---- ---- ------ Z ...Lining material--- Size: Diameter----�U...........Depth-------__-T---/------------ �0, -Cesspool: Distance:from, nearest well-------------_--Distance from foundation.- ..-_---.____:Lining material------------------------------------- C] Size: Diameter-----------•--------------------------Depth ---------------- ---------------------- --------Liquid Capacity--------------------------_---gals. Privy:, Distanc jrom-near6st well----- - . ....... -_Distainc6,fr6m nearest builcling.-___� -------------------------- -------- ji - .. . . . .. : ".. -------------------------------------- Distance I to nearest lot line.---------- ----------------- Remodeling and/or, �epairin 3. (clescribes__' ------------------------ ........... ... ......... - ----•-=' i1 . ........7-- ...................... ------------------------------------------------- ------------------------------------------------ -- ------- ------------ - , -E..; ------T---------------------- .................... -------- ----------- ........... .....6'. ----------------- ... ...... ...... --- - ------ I hereby certify that .1 ve prepared this application and that the work- -will*6-e done in accordance with San Joaquin---County..... ordinances State I in Local Health District, sand rules Qd rectultitions oft'1�g�n (Signed).... ------- --- ----------------------------------------------------- -----------------i----------------(Owner and/or Contractor) By:.............................. di............7--------------------------------------------------------------------------------------(rifle)---------------------------------------------- ---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED tly_/y---- DATE 7 --------------------------------------- ---- ------------ -------------- REVIEWED BY__-----------=-----$-----------•---------------------------------1r- ---------------------------------------................ DATE BUILDING PERMIT ISSUEDI ---------_------------------------0---------- ---------------- DATE------------------------------------------ ...... 1 ------------- ------- ------ Alfera ions and/or repomm ations:------------- .7-----------_i��.....-------------- ---- ------------- ------------------------ ..........A%....... .......... ------- - ............ ---------------�_-------------- kz:---------- ................. ----------- ----------- ---- ----------------- --c ------ ..... -----------------------_ ----------- __4........ _21� & ......... . ...... .... ..V. ----- ------------------------------------------------------------------------------------- ---- ---------------------------------------- ---------------------- .......... ------------------------------ ------------------------ FI NAL INSPECTION BY:] ------------------------ _-------t-L 40"g tp .............. ............. SAN JOAQUIN�LOCAL HEALTH DISTRICT 130 South American Street i 300 West Oak Srreot 124 Sycamore Street 205 Wait 9th Street Stockton,California Lod[,California Maniacci,California Tracy,California ES 9 REVISED B-S9 2M 5-61 ATLAS