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--------•------------ APPLICATION FOR SANITATION PERMIT Permit No. ...1...�_1...�..�`' --------------------------- ------ ----------- From e) / / ---------- --------------- ---------------------- P Date Issued ....//,3 (Complete to Duplicate) This permit Expires 1 Year Date Issued_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the ork herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AN LOCATI N.... .. - �p ,�{/ , --- • P,_. ---"-""ice+..-�---...._ Owner's Name.-----•. ... ml ?_� . -----••- ------•-------- _ Phon Address---------Contractor's Name Name._.___ ¢ _ ------- _- Phone Installation will serve: Residence Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: N �! umber of bedrooms . Number of baths _ ... _ Lot size . >✓'� ` Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&Hardpan ❑ Previous Application Made: (If yes,dote--------------------) No ❑ New Construction: Yes ❑ NXOFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200"feet.) is Distance from nearest well_________________Distance from foundation-_-____...._.__--_..Material__.____ ` No.`of compartments Size ................................ ..____._._ •................. .----•...----Liquid deoth----------•------------ -Capacity, - pokal F' ld4 Distance from nearest wellAD-m-,-Distance from foundation- 1 Number of lines...__. __ _-••-- Distance to nearest lot line__�.�-'` •--•- --.----- Length of each lined Z)-e---------------_ Width of french__ � 1 " q� i u Type of filter material- s-Oil--..__Depth of filter material-.___/ "'.__Total length-- S ,Sgjp Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-___.._____------ Number of pits----------------------Lining material-------. Size: Diameter------------•---------- Depth--------------------------------- Q Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.__-.___._ ❑ Size: Diameter------------------------------------._Depth----------------------------------------------------Liquid Capacityels, Privy: Distance from nearest well-____________________----------------------------Distance from nearest building ❑ Distance to nearest loft line_________________________________ Remodeling and/or repairing {describe):_ -------------•------•-- -------•----••------••-•--------------•-•---•--••---------_-------••- ---- ------ -- ------- ------ : . . [ --- i.-v ... --•-----•------------•- - 1 hereb certif that I have prepared is application ar ..----_ ---•--• ----- --- ------ -- y P P d that the work will be done in accordance with San Joaquin County ordinances, a s, and rules and regulations of the San Joaquin Local Health District. ZT t [Signed -.. - 171- --4 fl [ •--------------------- L ontractorJ ay -•--•--••--•----•---- ------ -------------------------------------------------- (tris)------- --- - ---- _ ____ ____ (Plat plan, showing size of lot, location of system in reiatio o -�iurldtng etc., can be placed on reverse side). e FOR D ARTMENT USE ONLY APPLICATION ACCEPTED BY__ ._ ___-___-- f -------------------------------------------------- DATE_. REVIEWED BY---------------- -- ---------------------------- BUILDING - --------------- - -�--------------------- �- ---------. DATE---•---------.....---------•- BUILDING PERMIT ISSUED--------------------- ------••---------•------------ ------•--------------•---------------------- DATE_ A�erafions and�r r commendati s:---- ------------------- .T_ _X. .f • -- -•- "'--- - -F---- .----.-----•------------------------- FINAL INSPECTION BY:.... -- - -•.---- -- ------ Date..1--="- ----`-- 6.- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Strut 124 Sycamore street Stockton,California205 Wert 9th Street Lodi,California Manteca,California 'Tracy,California E6 9 REVISED 5-89 SM 8-81 ATLAS