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k FOR OFFICE USE: ---------------- APPLICATION FOR SANITATION PERMIT Permit No. .__ .�..L?. ----------------------- --------------- ------------ -- (Complete in Duplicate) (1 6 Date Issued ____._ :_�.�. Application is hereby made to the San Joaquin u�eLoclt Expires 1 al Health District t fo oa "Dante Issued � 4� _ Z,;2—-7 ^0� � pp y q permit to constr t and installthe work herein escribed. This application is made in com with Cour, rdi nce No. 549. �61�`f2!r- JOB ADDR )l TI � ....1 ,,' F ... _1. ..... Owner's Name. -------'r r Phone---................................. Address �,�;.� _----- ._�.,f' _,- t ._.�-,Q ._.. f --T Contractors Name---- -- -_. . *_C�-__K____..-- -- -.-------------...... Phone. .199�_Zf Installation will serve: Residence [ p rtmen House [-] Commercial ❑ Trailer Court ❑ Motel C] Other [3Number of living units: _/---- Number of b drooMS3__- Number of hs _t-2/.Lot size ..,��/�-___e__�__ ------_____--- Water Supply: Public system ❑ Community+ �j tem ❑ Private_ epth To Water Tabled` _'-- ft. F ! T Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ay ❑ Adobe L lard n Previous Application Made: {If yes,date____________________) No ew Construction: Yes ' No ❑ FHA/VA: Yes No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS:- (No PECIFICATIONS:(No septic tank or cesspool permitted if pi}blic sewer is available within 200 feet.) 00, Septic Tan • Distance'from nearest well____ _------Distance from f �ation___ .,� r� --:...Li Liquid de th__f� ial.--------Ca-a = No. of compartments____. _...size q P•...._.D'stance to nearestct � p79 -�is t Disposal F' d: Distance from nearest welL_�_f-_Distbnce�from�foundation_� lot line._... '�,lt__.. Number of lines___________________________Length of each line_o4__S4.2,. �3.e_V#1Nidth of trench.___ Type of filter material._ _ . __ Depth of filter material_._-/_�F-/ ------- length--------,rrp0%...._..-` � Seepage Pit:. Distance to nearest well_,�,7b__-_-Distance om f undation___-_ . Distance to nearest lot line_________________ ©_ Number of pits.-„Z-------__ g �_---.Size: Diamete - __ _. p Linin material------------ - r� -- --___Depth- Cesspool: Distance from nearest well-----------------Distance fro oundation---__.--__-_.__.___.Lining material-------------------------------------- ;E Size: Diameter------------------------------------ t ❑ •-Depth----------------------------------------------------Liquid Capacity------------•-------------..gals.--,,6- . .. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____-.__________________________-,_._---- ❑ Distance to nearest lot line------------------------------------------- -----------------------------•-----------------------••----------------------------------------- i Remodeling and/or repairing (describe)-----------------------------------------•------------------------------------------------------•------------------------------------................... ¢i -----------------••-----------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------•-- --- ------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t law and rules and regulations of the San Joaquin Local Health District. ,tz-..(Signed)= _ ; ... _.l�.�q _ • ----------------•---•- (� Contractor) a By------------------ ----------(Title)----------------------------------- .....-------------- (Plot plan, showing size of lot, location of system in relation ells, buildings, c., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --------------------------------------- -•-----------••-----•------ DATE-- ;-----t) — ------------------ j r REVIEWED BY.------------------------------------------------------------------------------------------------- DATE ......--•--------- ....................................... . BUILDING PERMIT ISSUED-----------------------------------------•--------------------•------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:______-. ------- . ----�--------�--�- -�Tt��-------�'S-------------- ....................................................` ---------------------------------- ...................................... r -•................. ---------------------------------------- ------ - Y i • -FINAL INSPECT BY:- Date------- .S� � � 1 SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street 114 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59:.,211 5-62 ATLAS o