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FOR OFY ICE USE: ------------------------ -------- .--------------:- ------------ -- -------------------------------------- APPLICATION FOR SANITATION PERMIT ,� ;Permit No. ..../ ------ --------------------------- _----------- (Complete in Duplicate) -Date issued __._ -_..-------- -------------------------------------------- This Permit Expires 1 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. 549. JOB ADDRESS AND LOCATION... �____�Q_,_-- � Owner's Name__________ __ _/�"��__L°,S •---- a �7fQZ_-C--------•-•-------------•--------- -------------------------------------------- Pho �7_�1 Address----------------------------------•-----•------ o- E' Contractor's Name!-- _7 ±F s J!, J {- -.t1?. _r-............--------•------------------------ Phc ...... .I.... Installation will serve: Residence EI Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units-. ./.-. Number of bedrooms._ Number of baths I.. Lot size ...,XS__*7A--- __________ Water Supply: Public system [ICommunity syster ❑ Private Depth to Water Table ________ ft. Character of soil to a depth o43 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IffeHardpan ❑ Previous Application Made: llf yes,date--------------------1 No ❑ 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.) S is T Distance from nearest well___.•_..-______-•Distance from foundation------_-------------Material................................................. No. of compartments--------------------------Size_.._...----------------3_._-_Li uicl de th--------------------------Ca aci ^� Deosal _ Distance from near" t we l ____.._.Distance from foundat�..i Q.........Distance to nearest lot line__.__•_...__..... (� Number of lines._____.__ _________ _________Length of each line;:.._. __�_________.Width of trench___ _!f !l _.____.._.._."d Typeof filter material. ,4 _ p g_____De th of filter matena _I�!�_..__Total length .Pt...f___________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line........:........ ❑ Number of pits----•-----------------Lining .material-----------------------Size: Diameter------------_--•----_Depth-------------_-------------. _. Cesspool: Distance from nearest well-----------______Distance from foundation--------------.----.Lining material------------------------------------- 13 P ------Liquid Capacity--------------------------..gals. Size: iameter.-•---------•-------------------------De th----•----------------------- -- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___--__--_________________.____.___.___._ ] Distance to nearest lot line------------------------------------------- ............. ------------- Remodeling and/or repairing (describe):--------------- ----- --------------- = -----------------------------•----- ------------•.............................................. -------------••-----•-•--•----------•--------------•----------•... :. ------ ... `� - ...----•-------•-----•................................•--•---•-•------------- .!!_�- _.. ..... .� ��._7....r__..--••-•-----•----------- 1 ---------------------•--------------------•--••-------------•--•------------------------ -------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and 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. - y � J y�,1� r-1�•� Tve.ft (Signed)....... I 1 Q _.__ _c--1--i -------------------------------------- By: Contractor) f>l _ sy:.................••---•--------------------------...----------------------------------------..... ......---- --�_ _.e(rr)s)-------...----------•--• -•-°-----•----------------- --------(Piot plan, showing size of lot, location of system in relation to wellildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- •- - - - - --------------------------------•------'--------------- DATE---6--'-'---- 6- ------------- REVIEWEDBY--------------------------- --------._... _ . --•---------------------------------------------------------------•• DATE---•----••--•------ _ '= . BUILDING PERMIT ISSUED--•--------------------•-------------------------------------------------------------------••-•.... DA•TE--_-------------------- Alfe ations a /o recom ndations------------------------------------------- / ...... rs-ez /------------ ��` ----- ----- ---..--- ---- ---- r------V, � ------------------------------------------------- ----------------------••--------------------••----••-------_---_---- ---- ---------- ------------------------------------•- ------------- ----------------------------------------------•--------------------------:.....-:_...........-----._......._..--------._.......__.._. ------------------------------------------------ ---------------------------------------------------------------------- ............_.--•--------------------•------------------------....._---------- ' (p --_ .� FINAL INSPECTION BY:. Date ------- ------ ------------------- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Strut 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Er 9 REVISED 0.89 9M 15-61 ATLAS