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FOR OFFICE USE: ---------------- ------ -------------- �� ` :.t � ,. /' ✓ ----------------- APPLICATION FOUR SANITATION PERMIT Permit No. ___ ` ......... -------------•-------- -----1--- 7r-- - (Complete in Duplicate) _2__,- This Permit ExQires 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. 1. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND O AT ON - _/._' �� saz_f?a__ ... 6Q-cc? .. .. Owner's Name I�'.. ----------------------- ----------------------------------------------------------- Phone........-••---......--------------- Address......------------- I�... 77— �---------- ---------------- ------------•----•--••----------•-•••--••-•-•------- Contractor's Name- _--- �1C� -- -�----- - ------ Phone.�c'1 ..(a.a7._ � Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer - ourt ❑ Motel ❑ Other Number of livingunits: __ __i �,:_ Number of bedrooms.. Number of baths --- Lot size -------1 __4_______ ____ Water Supply: Public system. Community system ❑ Private ❑ Depth to Water Table.... ft. (u Character of soil to a depth of/3 jeet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M"H.rdpan ❑ Previous Application Made: (If yes,dote--------------------} No ❑ New Construction: Yes ❑ No �A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND IPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) S: Distance from' 'nearest well_________________Distance from foundation.__...._..__-__.___.Material................................................. . No. of compa tments------------------------- Ize--------------------------- q P. ------- Capacity........... ' rr _ Liquid de th_______________ _ . ........... Di al i Distance from] nearest well__ry. Distance from foundation___ .Q--/--Distance to nearest lot line_____f D.� Number of lirii s__..___1 Length of each line____ _Q_--� 7-Ar, of trench----- Type of filter,material-_-_- ____. _Depth of filter material........ ---------Total length---------------------- :M S �agei Distance to nearest weli__61_9Z!4_ __.Distance from oundation____-_l_Q_�..Distance to nearest lot line__.Number ofpits_______ _____________Lining matenal._.____o.G1_u__n__d_ afion Size: Diameter._._:�j�a�f�.-.Depth..__o�.��- ___._____CesspoollDistance fromilnearest well-----------------Distance from --_-_--.-._.__.._...Lining material--------------------------__-__..._-- ❑ Size: Diameter------------ ------Depth--------------------------=-------------------------Liquid Capacity---------------------------- Privy: . Distance from nearest well___________________________________.________..___Distance from nearest building------------------------------------------ Distanceto nearest lot line----------------------------------------------- ----------------•----•---•----•-----------------------••-----•----•----...-------------------- I Remodeling and/or repairing (dekribe):--------------- ----------------------------------------- - -- -----------•--•--••----•---------------------------------'--- -------- _ �� --- -----••-----------------------------•--•-----------•-------- ,j I hereby certif that I have prepared this application and that the work will be one in accordance with San Joaquin County ordinanc ws, d rules land reg rations of the San Joaquin Local Health stricf. l �jf; (Signed) �° _ ------- _ fL Contractor g )--------•- --- ._.. . L.T.b ------- - -•---•------- -------------------------- I y' -Il' --- -------- Title .. --•------- - ---- -------------( )-------------------------------------------- - ---------- -- I (Plot plan, showing size of lot, location of system in re latio wells, buildings etc., can be placed on reverse side). N FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- c'' -------- - DATEG_• ------------------ -- - --------------------------------------------------: ------ ---g-- REVIEWEDBY.... �-�--- ---------------------------------------------------•-------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------!Ij'---------------------=----------------------------_-_...-.-------•--•---- -------------- DATE. Alferafiops and or recommendations-------------------------------------------•-----------------------••-------••---••--••--•-----•-•----- •-----------•-•-•-•--- --.------ - ----•---- �. r �- -' - ., ...-•-.. ter ::: ------------------------------------------ --- Ijl � I 4, ' FINAL INSPECTION BY:.... '---- .... Date------------------- G SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 Wert Oak Street 124 Sycamore Street 205 Wert 9th Street ' Stockton,California Lodi,California Manteca,California Tracy,California Sr 9 REVISED 9-59 2M 5-61 ATLAS I ��