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FOR 0�1`11,CE L)SE: 4A -----� ---- "3 APPLICATION FOR SANITATION PERMIT Permit No. ............. (4 ---------- : (Complete in Duplicate) Date Issued ...��4 -- ---------------------- ------------E=M M=a M md= i This Permit Expires I Year From 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 JOB ADDRESS AND LOCATI. N_....:tEa..... ---�71--- .....................................---------------------/------:;------------- Owner's Name-------------------- ------ ------------ ------- ----- -----1.............. ----------------------. Phone_ ....................... Address------------------------- ........ .... ... . ........................ -------------- ---------------- Contractor's Name__��' . ...... - ---- ------ .... Phone- ... ....... ------------- 'L �r Installation will Serve- Residence Apartment House Commercial E] Trailer Court E] Motel [:] Other [:1 Number of living units- Number of bedrooms J< Number of baths _L- Lot size ------------------- Water Supply: Public system Community system Ej Private E] Depth to Water Table 4,!2 ft. Character of soil to a depth of 3 feet: Siir�d []'❑ 'Gia" E]l __Sandy_JL_ [_Loam_ ClayLoam oa-M,0- _Clay b, Adobe& Hardpa I n ❑ Previous Application Made: (If yes,date___________________) No E] New Construction: Yes ] No �!`HA/VA: Yes [] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available_ within 200 feet.) from from nearest well__________________Distance forn ..................Material......... -------- ...................... No. of compartments.._.__-....................Size.................mm----------_Liquialepth----- ......Ca p allc i t-y...............I------- osal -`ie d: Distance from nearest well_________________Distance from founclation.-L-A------------Distance to nearest lot line....__ Number of lines.. .................------------------Length of each line........ -------Width of french....... ............... ��yr r -oll 4 ,��, Type of filter material. --------------------Depth of filter materi6l—T&61 length___________-_--__"__.-____=__.___-_ ----� to nearest lot li Seepage Pit: Distance to nearest well__�4-(K ----Distance from founclafion_%Q:�.......D ne--- Number of pits___,_______________Lining Diam6ter_—__U_-_/_f------,Depth_ ------- 9, -i----M_M_ I q-Z, Cesspool: Distance from nearest we' ll..-------------!-.Distance foundafFion----m------ Lining material..._.._.____..._____---- _._______ ❑ aterial..............---------------------E-1 Size: Diameter. '..Depth------ ------------1------------------------------7Uq6id Capacity.......... Privy: Distance from nearest well__________________ _______._____.__.____o.___._Distance from nearest building_..-...___.__..._.._.:..._.___.___...... 0 Distance to nearest lot line.............m------------ T ------------------------•-•------------------------------------------------------------------------ Remodeling and/or repairing (describe):------------------ • --- ----------------------- ....-----------4 -•------:...._.----...-------•--•- . . . ............ -------- ----------------------M-------M..................... ----- ...................... ------------M------M------ ...........M............_.. :. - --------------------------------------------------------------- ------------------- ---- -- ----e.. ....................................... -------- .................................. ................m------------- .............I---------------------------------------M........7�_.-.. �/ -------------........... I herebtyerfify that I have prepared this application and that the work will be done in accordance with San Joaquin County c _e ordinan es. ws, and rules and regulations of the San Joaquin Local Health District. ---- ------- (Signed--- ------Q_ .- d i -9,�-e.- -_ ..- ------ Contractor) i ------------------ By:------------------------------------------------------------------------------------------- (rifle)------------------- ------------ -------- -------- (Plot plan, showing-size of lot, location of system in relation f e is, uildin;, etc., 6"Zn be placed on reverse side). /�/Wz FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- j -- DATC'__1_M_M5---- ------------------ REVIEWED BY------_----------------------- - r- - - DATE BUILDING ...............m.............m............................. PERMITISSUED.................... ...........................................................................I.... DATE---------_---------_mm-------------------------------- Alterations and/orp mmendations:--------------- ......_i. -----------------------------*--------------- -------------- -—----- �k ...... - �4 -------------------------------------••------------ ......M------I.........................M----------------------------------------------------------------------------------------------------------------------------------------------------- .......................... ------------------------------------ ••---• --11--- ---- -------------------------------- ---------------------.-------------------------------•------------- ------------.- ----------- Fr FINAL INSPECTION BY:...._ ---------- Date-__-- Z----—---- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 FIEVIStO B.59P ZM 3-61 ATLAS