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FOR OFFICE USE: �._�. "----------1 � __----. ------------------ ------------_----. APPLICATION FOR SANITATION PERMIT Permit No. ....J__ 1.. --- ---------------------------------------------------- (Complete in Duplicate) Date Issued ..-•--__.71 _____ -L --- -_._.._.___________-______________________________ 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. D l't(, -'. &r&i-c.7—A�r c-6-Am- QQ �y JOB ADDRESS AND LOCATION__. ..fir.-.XIP......` -.__-- ---_9.-1--------------- ..--- --00_/ l Owner's Name =fl L �.V ------ -•• - Phone._.... .1 Address �s !! ,. � -----------------------------...............--------•---------------------•---------.. ----------------- ---- Contractor s Name-------- 7 --•...................I.._....------•- Phone----------------------------------- Installation will serve: Residence Department House ElCommercial [] Trailer Court ❑ Motel [I Other [:1 Number of living units: ____)__ Number of bedrooms .._3. Number of baths .... Lot size ----47 _____________•--•-_------___-_-- Water Supply: Public system ❑ Community system ❑ Private [W/Depth to Water Table _'*YPFt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe%-OMerdpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes PO'O'No ❑ FHA/VA: Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well_* __'_ _Distance from foundaton.10___--_____-M_ aterial �!.......�......A..!... ............'P...-.a.....lf.�..r. - --------No. of compartments_____---__-2. --------Size___ ..•Li Liquid de th___ - Capacity �- r 1 Disposal Field: Distance from nearest well.\TQ--------Distance from foundation....�Q____ Distance to nearest lot [ Number of lines........__--------------------__Length of each line_____-7_S'_-______.___.Width of trench-----�. . .................. Type of filter material._.r.Qc&______Depth of filter material___fig'_--_____.____Total length........t_-o______________--------- i —.JSeepage Pit: Distance to nearest well_-�Q�___----------Distance from foundation---+�a-------._-.Distance to nearest to line...` Number of ----------- -------- -.�•------------------ Cesspool: Distance from nearest well ................Distance from foundation--------------------Lining material------------------------.-----_--•-- ❑ Size: Diameter--...-•-•----------------------------Depth----------------------------------------------------Liquid Capacity............................gals. rn Privy: Distance from nearest well------------------------------_------------------Distance from nearest building._____.________•____-__.-_____--___-----. 1� ❑ Distance to nearest lot line--------- ------------------•---------------- ----------------------------------------------------------------------------------------------- . Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ 'I --------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ --------------------------------------------------------------; K. ----------------------------------- --------•-------------•----------------------------------------------------------------------------------------------------------------•-----------•------------------------------------ I hereby certify that I have prepared this app'cati and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulation t San Joaquin Local Health District. �] (Signed)-•---------------------------------------- ------ -------------- ---- --- --:-- --------------------------------------------------------------------(Owner and/or Contractor) b. By:........................................ ------- ------------ -•----•.. ......-•-----------------------------------(Title)----------------------------------•---- --- -------- (Plot plan, showing size of lot, location of syst m in relatio to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ---------- -------------------------------------------- DATE------ ! f REVIEWED BY----------------------------------------- (y• ----- --------- ------ ------------------------------------------------------- �------ -----i------ DATE PERMIT ISSUED-- ----------••------------------------------------or recommend'ations:_ a_ I.6.-.(_�_...___I_._.___ ---------------- DATE---------------------- ------------------------•----••----- Alterations and/ _ L.� .]a.............. �. .' .4_-_`� --------------- t3 - t .•._......._.. - -s----------------- .......... .............................................................. --------•-----•-•--------------------------------------------------------------------------------------------------------------------------- ------- --------------------- ------------------------------------------------------- _-_..----.--------------------------------------------------------------------------- ------------------------------ FINAL INSPECTION BY:..C,.........��u-__'_.------------------------------- Date----- ------ --- -----•--- ........ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California ' Lodi,California Manteca,California Tracy,California ES 9 REVISED 9.59 211 5-61 ATLAS W