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r'%-.OK urric..t ubt --- - - ---------- -- ------------ ---------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....:........__.____.,.. ` (Complete in Duplicate) _ ')-- _(o T Date Issued ...... ............... Application is hereby made to the San Joaquin Local Health i Year From Date Issued `._ pp y District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATION....... Owner's Name----------- - -- / } ' �Ll� �r .�� _---•---------------- Phone ------------•-------------- •-- -------------- Address-----------•----•------ ...tQ_/,�-�,��..`�....-- --••� `--fill.----------•-•-------------- - -- -------•-- --------- ----------•--••••... .... i Contractor's Name...... f._f .�ICr. _�1ra/E ------------------------•-•----------- Phone.•..--••- Installation will serve: Residence ��partment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ k Number of livingunits: I... Number of bedrooms _ . Number of baths _ _.- 'Lot size ..11 - E•!,�{�3 ....................... Water Supply: Public system ❑ Community system 93'lrivate ❑ Depth to Water Table �ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑,.. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 93--Mardpen ❑ Previous Application Made: (If yes,date---------- ---------) No RA-' New Construction: Yes 9?'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 - - fo_u_ndation.--fa_/ --.Ma--terial__4iNo. of compartments- � Size- -- ��-� ..•. ..---••••-• -------Li uid de th---,� — ----• ---•---Capacity._ aQ_._.... Disposal Field: Distance from nearest well..-..--------- '-----Distance from foundation...- -. / _...._-Distance to nearest lot line.____.--. [� Number of lines......,�r-_- -- of each line-- `�r. s �------ -------Length �-�------ `� Width of trench..r2...----....---..._.---••---- I Type of filter material./to Depth of filter material... .----_--.-Total length.---.-� .•�_--__--- ✓ s Seepage Pit: Distance to nearest well----- ------_ f d Distance from unatio '�- n_-.. ._ -----..Distance to nearest lot line.- .. .� -._..._ �r Number of pits...-_-2------_--_--Lining material. ,rrW ---Size: Diameter__J9..........Depth-- -- -----•-•................ Cesspool: Distance from nearest well-----------------Distance from foundation-----------..------.Lining material..--....--_..----.....-_.:__--....-._ ; ❑ Size: Diameter_ ----------------------Depth-------- _----- ----------- ---------.Liquid Capacity ------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building ❑ Distance to nearest lot.line----------------------_•----_----.-_-___--- ------------ ----- Remodeling and/or repairing (describ 01: - -..-- - m ..�,... ---. --'•--•-- ---- --•-------------•------•------------•------•----------•----------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this..application and .that,the work wili.be-done in accordance with Sari Joequiri County ordinances, State laws, and rules a d regulations of the San Joaquin Local Health District. _ t a (Signed)----------------------- ---- ----------------•------------••------------- y � , or Contractor By:--------------------------------------------------•-•--- . Title � � - ------- -- - - --- _ _ _ _ _ (Plot plan, showing size of lot, location of syste i relation to wells, buildings, etc., can be placed on re side). t R EPARTMENT USE ONLY "� { APPLICATION ACCEPTED ---------1��-I-------------------------•--------- DATE__ .. .....;;z_ REVIEWED BY............. �.�.,�.�- , BUILDING PERMIT ISSUE DATE ---------- n < --- ----------------------------•---- ------------- :------- ,4TE------------- ------------------- --- -- Alterations and/or recommendations:---i-`Z --a -. -------------C.= A. 'RP =•------- ----------------------------------------—--------------------------------- -----•..I---.----••----------•----- -------------------------------------------------- -------------_---- - -------------------- -------------- ------------ FINAL INSPECTION BYE.... ---. rt - ----- - -------------- Date-- r , -----•--==---------------------------------- SAN JOAQUIIN LOCAL HEALTH DISTRICT 130 South American Street V300 West Oak Street 124 Sycamore Street Stockton,California�'�"'— —""`"'4 1�' 205 West 9th Street Lodi;[allfornia Manteca,Callfornia Tracy,California EB 4 REVi6Eo 8-69 RM 5-E1 ATLAS