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FOR USE: �y-�� i . --- --- -- - - -------- ----------------------------------- ---------------------------------- 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 L al'1-Iea1#h District for a permit to construct and install the work herein described. , This application is made in complian pwith-County-©rdinonce°No:-549-.- , - JOB ADDRESS AND CATION T _ �.�..1--...........................----- ------------------ Owner's Name------- f Phone----------------------------------- L t - Address -------------- ------ t �us�-�iC.Xk - Contractor's Name____ I s -- -•--- ----------------------------------------------- '--......- Phone c Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ) Number of living units: ____ __ Number of bedrooms __..3. Number of bath ____.L Lot size ---------------------------------------:........--_--____.._ '--. Water Supply: Public system_�Community system ❑ Private ❑ Depth To Water Table_S? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand am ❑ Cla 'L�m ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: {If yes,date----_---------------} No- New Construction: Yes No [3FFiA/VA: Yes ElW---No O TYPE OF INSTALLATION AND S4CIFICATIONSc � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest wel!_ _Distance from foundationd_______.Materl... .._ r, ...... No. of compartments--------- ize...- p_ yQ_.---Liquid depth------- ./�.�_-.Capacity.... Dis osaI geld: Distance from nearest well___.._._-__ Distgnce from foundtio ] -__Distance to nearest lot llne�....5.___..... p Fy f Number of lines_________rd�----___-_.-______Length of each line_. __ ;.�?_____-_.Width of trent / ; c Type of filter material.._) .V-04rDepth of filter material___-146:-�_--_--_Total length___ __�-------------_--_________ �1 I Seep it:. Distance to near t well-777':�"Di"stance'fro"m"foundation__-/P��__-__.Distance to nearest lot line_4S___J_____- Number of pits_ _______Lining material__' Size: Dia meter---3_-_.----___ Depth--- _�_______________ ' Cesspool: Distance from narest well.................Distance from foundation------}._ --------Lining material................... ___.-------- t - ❑ Size: Diameter---I----•-----------------------------Depth-------------------J-----------------,' -----------Liquid Capacity............................ Privy: Distance from larest well-----------------------------------------------I-Distance f"r')oom nearest building------------------------------------------ ❑ Distance to nearest lot line---------------------------------------------- -•-----------•---++��:.:f-----.-------•----------------------------------------------------------- Remodeling and/or repairing (describe):--------------- -i------------ � )�..- -------------------------------------•--•----•---••------- p --•----- ` ----------------------------------------------_-------------S-----------------------------.-------------_-.___.___________________. -----....__-____._______-____---------------------------------------------- ............ - I hereby certify that Ikams rLpared this application and that the work will be done in ac Jordance with San .Joaquin County laws, ordinances la , an ules nd regulations of the San Joaquin Local Health District. t (Signed)... ------------- - ---------------------------------------------------------------------------------•------ -------(Owner a r Contractor) "1 By: ------------- --- i -- -- . ----------------------------•------------(Title)---��- --- --- ------------ j (Plot plan, showing size of lot, o tion of system in relation s, buildings, etc., can be place on reverse side). —..-- -FOR-DEPARTMENT-USE,ONLY�---J APPLICATION ACCEPTED BY-__ '� - - - -- --- DATE___ „ �p ----------------- REVI EWED BY------------------------------------------ --------- --------------------- ----------------------- DATE----------------t ...................... �. -----••--••--••------•------- BUILDlNG PERMIT ISSUED-----------------------------t____-- --------------- -- ------_-- . DA (((/// AlTerafins�nd/or recom en a ions:__- ._.._ T........ rfl -- /P __ -/-= ::.........................••--.•---- s-�s ��-- ------ -04 -------------------------------- ---•--...-_...--------------•--------------------------------------------------------------- --------- ---------------------------------------------------------� -----------------------------------------------------------------------------_------•-•.......------------------------- -------------- ------------------------------------ ------------ ------------------•---------------------------------------••-------------------------------------------------------------------------------------------------------------- --------•- -------------- •--------- --- - ---------- ---- -------------- -----------------------------------------• 7 ------. -------------- FINAL INSPECTION Y: ..... .... .. .. ------ ------- _._ __ Date. --------------- SAN -._ SAN JOAQ LOCAL LTH DISTRICT 730 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9t 'Street Stockton,California Lodi,California Manteca,California Tracy,California 1:7 ES 9 REVISED 8 59 2M 5-62 ATLAS