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FOR OFFICE USE: / -- ------------------------ -------- -- .--'-_-.. i .. . -. ...- ��- -� -�t -�� a- APPLICATION FOR SANITATION PERMIT Permit No. .. -14.-.._7.. .` .. ��-� -G-L----------- (Complete in Duplicate) 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 Ordinance No. 549. i JOB ADDRESS AND} LOCATION......... -•--------------------------------------------------- �-:----- _ -- -------------{�-- ------- ft Owner's Name.... - ........ � V--------------------- ------ Phone-� � Address . ...-�. _�? .. p -------------------•--••----•- f Contractor's Name__.. :. o-u e. C------------------------------- •----•--- Phone..... j.�� lnstella+ion will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ ' Number of living units: ..__1-- Number of bedrooms __Z. Number of baths .-- •-• Lot .� ._19'a -•------------------------•--...._ Water Supply: Public system ®ommunity system ❑ 'Private ❑ Depth to Water Table .. _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(3-'Hardpan ❑ Previous Application Made: (If yes,dote--------- -----) No O---New Construction: Yes [J-'No ❑ FHA/VA: Yes ❑ No ❑— TYPE OF INSTALLATION AND SPECIFICATIONS: - " I— - (No septic tank or cesspool permitted if public sewer is vailable within 200 feet.)' Septic Tank: Distance from nearest well---------------•-Distance from foundation....................Material................................ ___.............. No. of compartments----------------- •-------Size---------------------•----------Liquid depth.-------------------------Capacity........-•-••-•--_..._. Disposal-1 field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line................. C(i Number of lines............... --------------------Length of each line-------------l----------•--•--Width of french.--•-----•----------....--------•-• Q Type of filter material-------------------------Depth of filter material....----_--_--l-----_Total length...-------------------------....may...... Seepage Pit: Distance topearesfilwell--__-_-'----_._.Distance f j m dation..../a___._--.__.D,is�t-1 �e to nearest lot line_` ...-...-.. Number of its----------------------Linin material--__.1_- ..-_-------._Size: Diameter----__n--------•--Depth-------X5............. Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material_.---------------_--_.---_-_--.---._ ❑ Size: Diameter-------------------------------------Depth-------------------...------------------------------Liquid Capacity----•-•--------------------------gals. _ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building Q Distance to nearest lot line----------•-•----------------------------------•---•----•-- Remodeling and/or repairing (describe):.. ----------- ------ -- •-_ ------------------------------------------- -- rad +:his •---- . �L - -------------------------------------------------------- -- . -----------------------------------------------------------' I hereby certify that I have prepapplicationand that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed --. •-------- ... y a"'`•AJ --------------------- --------------------------------------- (Owner end/or Contractor) :. . -:_ l3 • --�"" �.--....:'`-�_r�.J� -... ---- - {Title]------- • - ' 1 (Plot plan, showing size 0{�lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---- ---------------- -----••-------------------------------• - DATE---- REVIEWEDBY---------------------------------------- -• -------------------- --------------------------------------------------------.. DATE------------------- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE. Alterations and/or recommen$a+io :-- -8 _, •'r- ----- -••-�-- -- • -- ��-�'C-�-•�'-�--7 k-��--- r- ------ate•_-- -'�--- - -•�•--�-------------- -•---•--f�'r-- ---................ .. ------------------------------- ----------- _•--•--•----- FINAL INSPECTION BY:.. .._ ------ -- C� ,Date _ 76' _L 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 8-99 RM 5-¢1 ATLAS '