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FOR OFFICE USE: u - �1 APPLICATION FOR SANITATION PERMIT Permit No. ....-- •-•.•. --- --------------------------- ------ (Compete in Duplicate)- lDlitDate Issued .....; - ------------_--------------------------------------- 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. JOB ADDRESS A D�LOCATION '---'�'--. �-� .......k,_. .- ;t ----------•-----•------------ /� Owner's N r1�e_.. u•`'`� ,----a`-� -c t``� -----•------------------•------ Phone.(a 9----.�.....� - Address-----�1. kl �. . ....... .� Contractor's Name. ......--- . ` '� ------ M tel Other r-e�- ----- Phone. .�...... V +. Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ `I ❑ ❑ Number of living units: ---I---- Number of bedrooms J-. Number of baths _...}__- Lot size ..... .... .....•-.- Water Supply:I : Public system E] Community system ❑ Private M"'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 B�New Construction: Yes [a--N-o ❑ FHA/VA: Yes ❑ No ©---, I TYPE OF INSTALLATION AND SPECIFICATIONS: R (No_septic flank_or cesspool.permi#!ed-if.public_sewer.is available.Within 200 feet,)_ ..... - eptic Tank: Distance from nearest well_________________Distance from foundation-------------------.Material.................................................. No. ofcompartments• ---Size----------------------•--------.Liquid depth-------------------------capacity...... .... «.... I Disposal Field: Distance from nearest well---.____PD------.Distance from foundation __-!-------- ----------------- nes to nearest lot �--•--_---- Number of lines--_____!___.-___- ---- ---------Length of each iine_____� 1 -�[�ft Width of trench._..x ____...__________..-- -- E Type.of filter material-----li ------Depth of filter material____..f_ -------------Total length_-_..., .• b d-------- - - ` Seeps a Pit: Distance to nearest well------L_ . " _.__Distance from foundation_...._��_.___....Dist rte to nearest lot ._ __Linin material -----Size: Diameter___ __.......Depth_____ Number of pits.:....- � g ! Cesspool: Distance from nearest well_�._----------Distance from foundation-------------------.Lining material----_-------------------........ i ❑ Size: Diameter----•- --------------------------------Depth----------------------------------------------------Liquid Capacity-------------------._-_-gals. Privy:, Distance from nearest well-------------------------------------------------Distance from nearest building.___-.-_________----._-_------------- Distance -_--_--.______- Distanceto nearest lot line----------------------------------------------------------------• -------------------------•---------------------------•---------------- Remodeling and/or repairing (describe):----------- ------- •.... .....0 "[' ?--------------------------------- --------------------- -•--`-------- -- - q-•- —-- ----------------------------------..............................................-••------------• --- ------------- --------------------------•- ---------•-•---•---------a-•------------•------------------------------------------------------•-•-----•-•--------- •------•------•-------............----•---.-----•----••---------- I hereby certify that I have prepared this application-and that the 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 "• e G/'�`- .-..(Owner and/or Contractor) , �6 l _ Title ............ By._.T..................aL car.=' .___.__ �1 �- __. _.__________»..._____._._.________._______-_ n-ter----- (Plot plan, showing si'�f (!,'location of system i afion to wells, buildings, etc., can be placed on raver side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --------------------------------------- DATE--- ----------- REVIEWEDBY-------------- ---- --- DATE----- -•-- --------------------- ------ J BUILDINGPERMIT ISSUED----------------------- ---------------•-----------------------•----------------•-----------------••- DATE-----------------------------------------------------•----- Alterationsand/or recommendations---------------------------------------------------------------------- -----•-------- ---•• -----------•----------•------•----•-----------------------._.. � -•------------------•----------•---------- •--------------------••----------------.-_-------•-•--------. .......................................................... -------------- •-------•-- •-------------•--- - ---••-- ----------------.----------•----- ---------------------------------------- ----- FINAL INSPECTION BY:.... -� , ------------- Date........ lQ.. ----------------------------------------- SAN ----------------------- -SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strut ' 124 Sycamore Street 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5.61 ATLAS p .,