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FOR OFFICE PS -. = ------------- - r APPLICATION �R SANITATION PERMIT Permit No. ._1 ..- -• -.•- ------------------------ (Complete in Duplicate) )J - Date issued __.__..--------------__.._._ This Permit Expires 1 Year From Date Issued f ' ! Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta t e work herein described. This application is made in compliance with County Ordinance No. 549. /33...... i ! ......... a`7 3z. ..-�•. JOB ADDRESS LOCATION--..10 - ,c� T c - ------------ Phone---• -------------------------------- Owner's Name----- ------ .i-....._-X_L— -------- -- - Address...........S_ . __ -----•-•--- ----� •---•---------------------------------•----------•--------------------------------•----••----•-----•.......--•----•-•------••••-- _..._....... Phone-----------_--------------- Contractor's Name.' f .. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court .ER-'Motel ❑- Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths)-------- Lot size -..._________-____•--'..............•---_-___.--...____:__ Water Supply: Public system ❑ Community system j] Private ❑ Depth'to,Water Table -------- ft." r Character of soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan C] " Previous Application Made: (If yes,date_�-------------____) No New Construction: Yes `�No ❑ FHA A: Yes ❑ No [� ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2.00 feet.) y v Sept' ,�fank "`. Distance from nearest well_____________i..Distance from foundation___.._______.'.-----Material-----_._.-__:_:..........._..__::...._._........ �i No. of compartments. '-__Size. y Liquid depth Capacity 1 ;= ...... Dis sal Fi Distance from nearest well_..___Distance from foundation---Distance to nearest ine................. i - Width of trench______ . Number of lines----------� __________________Length of each line_-___-__ " I �'Q- Type of filter material_ -------Depth of filter material.____:___.Total length____':._ '_.....___.- Seepage Pit: Distance to nearest well_ -------Distance f m foundati'. Gly '+s_.Distance to nearest lot Number of pits-------I--------------Lining material,_....-%lC -- ameter., (-.:Depth__.---- '----...--------. 4 Cess ool: Distance from nearest well_______________Distance from foundation9._- "______-"-_.Lining material:______.__..____r:.________.._..._-_ [� Z., Size: Diameter------------------------------------•-Depth.-- F r ---Liquid Capacity.- 0 gals. ---------------- ^_ Privy: Distance from nearest well------------------------------..----•---- - ---Distance from nearest building___+______.--, -----_ + ❑ Distance to nearest lot line---------------------- ----•----------------•---------------------------=--------- ------------••-------•------- ` ' Remodeling and/or repairing (describe)---------------•------ ---------------------------------•---.....-•------------.......-----•-------------------•-----•--•------••---. S ------------------•-•--------•------- ----------------------------------------------------------- ------------•----- ------------------------------------------ ._. ..--____-_ -_--..___....._-_-______---___..__-.--------------------'� .. ___-_-_______.._________---______--_-_____--.-___-________ _-. --__- .. ______ ________---._._.__._________ 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 and reg ations of the San Joaquin Local Health District. I ._..{Owner and/or Contractor) plan, ------ BY: '------------—---------- ---- --•-•- ------ --------< .a `= - ; (rile)_.... - y ( 9 can be placed on reverse side). Plot showin sire of to t ation'ivQ wells, buildings. etc., � I OR DEPARTMENT USE ONLY APPLICATIONACCEPTED-BY---- � ------- ------ ----- -------- ------ --------------------•---------------- DATE � ~� --------- --------- REVIEWED BY----------------------- - ---•------------------------------------------------------------- ................. DATE----------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------- ------------'=------•------------ DA7E.. i Alterations and/or rec t1 t, S. ----__-•-- F'.'_ " = ..-�_1_ c4 ..._-- '1' --•---------------------- - f -- ...................................•------ .....--- ---- ----------------------•--------------....._.:..----------------------------... r --... #..._.. ----------------------------------------- ---------------------------------------------------- FINAL INSPECTION BY:. Date. SAN � JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Srroet 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,Callforn"iv Mea»ca,California Tracy,California E6 9 REVISED 8-99 pM 0-61 ATLAS i.