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FOR OFFICE USE: �,- ------------------------------- --------------------------- (� _-.. If__.___.._-.11111111-. APPLICATION FOR SANITATION PERMIT Permit No. .,1... ...�J.._ ---------------------------- ----------------------------------11 --- (Complete in Duplicate) ? I � Date Issued .__•l. .�U ______________________�....._._.._._..___.._._ This Permit Expires 1 Year From Date Issued eucandApplication is hereby made to the San Joaquin Local Health District for a permit to const ' install the work herein described. This application is made in complia ce.wi yh County Ordinance No. 549. Lt 5•—2_S JOB ADDRESS AND LOCATION------- - - - -------- ---- -( ;.vY Owner's Name, --------------------------- •------------------------------------•---------------.._ Phone. �rr� Address-----�I1.11= , t1 ......ov. -_-----•--•---- 1111 ------• • -------------------------------------------------•----------------•------•---------------•--------- Contractor's Name- ---•-----------------------------------------------•-•-•------•----------------------•--------•----------------•-•---•-- Phone..-•--_----••---•--••----•----••- II Installation will serve: Residence.] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number f living units: ...1-_- Number of bedrooms ________ Number of baths �- � �_:?.: hot size ---?----�--�.."-------------•--•-•-------••--••--- Water Supply: 1'Public system ❑ Community system ❑ Private ® Depth to Water Table ;Itis"_ ft. �. -At--. r4._.r.. �- _ •t-.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 )Clay Loam E Clay ''•Adobe❑ Hardpan_ Previous Appli ea�tion Made: (If yes,date.-.--------________1 No ,Q New Constru tion: Yes R] No E] FHA/VA: Yes [3 No [ITYPE. OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Tank: i ; Distance from nearest well_.�0 -------Distan;e from foundation----------- Septic ._......Material_ ............................ I No. of com artments__ ____________________Size ?'fft_ :_ �Li uid de th__..__'{__._..._________Capacity-1Zf!"� P --f q p. e Disposal Field:I ; Distance from nearest .well-'°----------Distance from foundation_..8---______.....Distance to nearest lot line line------.-__-.... I Number of lines------ ___ _________f Length of each line----ZO-1-___-_.-_-_---Width of trench_--7-:.�---____________-...._ Type ._± 9: --------Depth of filter material.--./,p----________T'otal length-/- T e of filter mat en Seepage Pit: Distance to nearest well--------------Distance fro foundation_1_a_-__----___.Dista cp to nearest lot line..----__-____- Number of pits__r�______________Lining materialwl -------____Size: Diameter____.''�__ �.--....Qepth__ C_-__--_--___-__--_---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-.-.._..____--_..._.______._-_.._.___ ❑ Size: Diameter------------------------------------_Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building-__._______.________________________-_---. ❑ Distance to nearest lot line- -----------------•--------------------------- -•--------------------,--------------------•---•-----•---------------...._------------------ Remodelingand/or repairing (describe):---------------------------------------------------------------------------------------------........-------------------------------------------------- --•------•----•--------- -................................----------•---•--•--------•--•--------••-•-----------------------------•-------------------------------------.--.-..----••---------------------•--•------------- -------------------------M------------------.---------------------------------------------------------------------.--•-------------------------------------------------------------------..................................... ---------------------• !---------------------------•-----•-----------------------•----••---------------------•--------•-----------------------------•--------•----- •--------•-•-•----...-•--------1111-•--1111----•----- I hereby certify that I have.prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stayte laws, and rules an regulations of the San Joaquin Local Health District. I P� (Signed)__.-------d__ Owner and/or Contractor --1111------------------------------------------------------------------- Y -�i----------------------------- -•----------------------------------------------------------------•---------(Title)----------------- ---------------- -- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side): R. �j FOR DEPARTMENT USE ONLY APPLICATIONI ACCEPTED BY- - - 410-4044144-------------•----------------------------•---•---------------- DATE-- - ---- �---------------------------------------- REVIEWEDBYik---•--•--------------------------------------------------- ------------------------------------------------ ........... DATE-----------------.... BUILDING PERMIT ISSUED-------------------------------------------------------------—-------------------------------------- DATE-•---------•--------- - Ir --- ---------------------------1111-• Alterationsand�/or recommendations------ --------------------------------- -----------------•---------••--------------•-•-----------------•-•---••--------•------------•----------------_---__--.- •-----------------•---•---•--•--._---.-----•-_.-------------------------------------------------------------------------•---•----------------.._......._.---.......... ......__.................... .........................-------------..... ........_.. -------- --------------------------------------------.-...-----------•--------------•-------•-----------•---••-----------------------------•--------------••- 11 ......................•-----•-...:.--••-----------.----•----------------------------- ----------------------------------------------------••------•-•-•---•-•---------------------------------------------------._....------- -----------•-•... .....J: l----------------- --- -------------------•----------•11111111-- -------------------1111-- ••--------------------•--•----...-----•--------------------------•-••-----•--•-----------•----------1111-- FINAL INSPECTION BY ._--- - _ Date............ .� _ f;�--- `F 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 0-59 $M 5-61 ATLAS