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FOR OFFICE USE: ,} . ------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.�......�fl.-----........ ------ ------ ------• --- -------------------------- (Complete in Duplicate) - —� -/Z --- ------------------ This Permit Expires 1 Year From Date Issued 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 Ord7-6-0— No. 549. f Q� p ►9 AVE, i _ n., cc�� JOB ADDRESS AND OCATION---•----•- _�_----- lel nhrEC f� . n / ) 11 ---•-- Owner's Name✓ `` " ------ / � d - c.tM -11. .L!1.11f 1 Address �1_. K------ � ` �'� z-,-•- __ -•-•- Phone 4 -7 2 Contractor's Name 1 .. ---- - " '". tD-}�1 :---................... Phone!.. --------------------- Installation will serve: Resident Apartment House [� Commercial ❑ Trailer Court E] Motel ❑ Other [I Number of living units: . _. Number of bedrooms 3--- Number of baths--Q--- Lot size ._1-i v_, .__�..p....................... Water Supply: public system ❑ Community system ❑ Private; ] Depth to Wafter Table __ '_ ft. - Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy``Loam Clay Loam ❑ Clay ❑ Adobe❑ . Hardpan ❑ I Previous Application Made: I I f yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ d TYPE OF_-INSTALLATION•AND-SPEC-IFICATIONS:-- .(No septic tank or cesspool permitted if public sewer is available -within 200 feet.) Septic Tank: Distance from nearest well.................Distance from foundation-___--•_----__---_.Material................................................. ❑ No: of compartments--------------------- -rSize--------------------------------Liquid depth_-------------------------Capacity----•------ ._ .. Dis al Field Distance from nearest well_�_Q_-_._Distance from foundatioC .__:..._.Distance to nearestClo �- --------------- Number -------------Number of lines_______I---------------- ___ Length of each line_.-.. �Z- G.Width of trencf�_.... ..... __._._____....... Q J Type of filter material._._______., _ __ Depth of filter material__�_ ____________Total length___`-_... _..-._._-_•.. 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..................................... ❑ ,,.,,Size: Diameter----e �------------------------Depth----------------------------------------------------Liquid Capacity............................gals. � Privy: Distance from neatest well----------------------------------------.-----.-Distance from nearest building.......................................... ❑ Distance to nearest lot line------------------------------------------------------------------........--------------------------------------------•----------------- Remodeling and/or repairing](describe)-------------- - -- ........................................ ----------------------------------------------------------------------•----------------------------------------------------...... --------------------------------------------------------------------------.--_.-------- ------•-----•------------------•--- --------------•-•------------------------------------------------------- ---------------•----------------------------------•----------------................................... ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St e laws;, and rules anregultions of the San Joaquin Local Health Disfrict: YV-.1111, -�Z—a-t14-d1c- ._ -------------------------------------------------------------(Owner and/or Contractor) Br----------------------------------------------------- ---------------------------------------------------------------------------(rtle)-------------------------...._.------------- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ! ' `------------------------------------------------------------------- DATE....... ---2 ----------- REVIEWEDBY---------------------------•-------------•---- -------------------------- ------•--------------------------- DATE--•-------- .. --*.......•--••-- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------- ------------------------------------ -------------- Alterations --•-----•-----------------------r-------------- Alterations and/or recommendations:-------------- ------------------------------------------••---------------•--------------------•--•-----•----•-----------•---------- ----..-. ----•---------- --- ----••------------------------------ ------------•----------• ------------------------------------------------•--..--------------------------------------- w ----------------------------------------------••------ -- ---- ------- --- ---- ----- ----- ----------------------------------------- ------- ------ ------ --- --- ------ . -----------------•---------------------------------------------------------------------------•-------------------- FINAL 1NSPEC Date........ - 2.I._T-f2 r� - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streel 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E8 9 REVISED 5-59 $M 5-61 ATLAS