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FOR OFFICE USE: ------- _---rf�_ APPLICATION FOR OR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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 ADDRE=SS AND LOCATIO a ------------ ...... �G..._.. /_r.e...... Owner's Name �--�s----- �C•- I -----------------------------------------------------•------------- Phone_.................................. Address------------------------ U d ` �- ,[... - + .tf �?.��t 1 -----[ .................•--------------- Contractor's Name.......---- f' �••GL--..!_101 ------ 'Phone.....................I......... . _ � - ---------------------- •--......------••------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel [-] Other ❑ .. Number of living units: ._-(____ Number of bedrooms-3__ Number of bath .,�z_Lot size ...... f._____ ... ____________________ Water Supply: Public systemommunity system ❑ Private ❑ Depth TO Water Table. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date-------------------- No [A,--1qew Construction: Yes 0 No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---_'_______Distance from foundation__ .. _..__.Mat rial..CC_R_r�G J� No. of compartments____-._it-----_ Size------- Q__-Liquid depth------!__'Lit—--------Capacity. _.. Disposal R Id. Distance from nearest well___ -^ Distance from foundation.I.P_1___-__-Distance to nearest lot Number of lines------- Length of each line___ att_.7 `___.Width of trench---- --- .y___________________ I +� Type of filter material.___�..___k_9p 5 � th of filter material__�_�_____.........Total length_,l__,S+tLj�__.________._--_-----. Seepage : Distance to nearest well_---�------------Distance from foundationj.o_---______-Distance to nearest lot line__±^..._.... IVNumber of pits---�:_____-_--_Lining material-_V-1-0-C►_k-Size: Diameter__,34 -----------Depth-_--off !_________________ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------._._.._ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity--------------------- ......gals. , Privy: Distance from nearest well--------------------------__---------------_-----Distance from nearest building--------:___________---_.--_______-______- ❑ Distance to nearest lot line Remodeling and/or .repairing (describe)-----------------------#'102. ]-----....�-a ----- ------- ------••-•--------.-__----------•---.-------------------••-----------------------------------•---•----•-------------•----•-------•---------.-------.----•---•---------------------.------------------------•--------- --•----•----------•---------------------•--------------•----••------••------------•-------------------•-----------------••------------------••------•-----•------•-•------------•------- 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, and rules ane regulations of the San Joaquin Local Health District. I \- —R --- ------ --/� (Signed) --- �,---------- ---------------------- ----------•------------=-----1� --- Owner and/or Contractor) • BY: •------------(Title)---- �................... (Plot plan, showing size'of to , 1 catlo of system in relation to wells, uildings, etc., can be placed on reverse side). k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -`."�— DATE �' ----T ----------------------------------------------- ------------- • I REVIEWED BY ------------------------------------------------------------------------------------------...------- DATE-------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------ DATE--------------------------------- -------------------------- Atte ations and/or recommendations:...l--4 _------- - ----------I_._.._._._ n_5. ---- R 2- ------ le 5sI -_-_-------- �.�- -------------------------- ------------------------------ •---------------.-_------------------------------------------------------------------------------------------•-........•------------------------------------- ------ ------------------------------------ - ................ ------------------------------------------------------------------------ ------------------------------------------------ ----- FINAL INSPECTION $Y:---- -------------------------------------------- Date............Z�/�----- --- •--------------------.-_- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California r'f Manteca,California Tracy,California ES�9 REVISED B-59 2M S-62 ATLAS