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FOR OFFICE USE: ------------------------------------ ------------------- ll / ..�� ------ ------------------------------- -------------•--- SANITATION PERMIT Permit No. ....., APPLICATION F(A _.._�.� .. (Complete in Duplicate). ._ �. �. � pDate Issued ...... -_-_--__-_.........................._:____.___.__._._..__ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constru all the work herein described. This application is;mad.e in compliance with County Ordinance No. 549. OO --r3� —�� sic-4uiC.�. '• _ � Q /� JOB ADDRESSAND LOCATION... .. . . ----.... ?-�f ! - Owner's.Name--------- -------------- ----------------_---- Phone---_-.------------------•----------- Address------------------------------Is-------------�Z*.ate ��``� -• - - :. ...- Contractor's Name ----------------------------------------------_. Phone............................. Installation will serve: Residence @ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: _I?...__ Number of bedrooms ._3-_ Number of baths An. Lot size .... -.•-.----•--------------------------- Water Supply: Public system ❑ Community system ❑ Private [�j Depth to Water Table -.70-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam W Clay ❑ Adobe❑ Hardpaniv, I Previous Application Made: (If yes,date____________________) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: N 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 '� Sprptic Tank:: Distance from riearest well---4 .------Distancq from foundation---)_Q----------Material--- ............. L �] No. of compartments-----._�-.----------_-Size--- . --g -s-- ---Liquid depth---------4 --------------Capacity.../.2-._0270...... Disposal Field: Distance from nearest well._jVO--------Distance from`foundationl__q�-----------Distance to nearest lot line-.-S.......... Number of lines___.. -___ ___________________Length of each line.'-___/--_--.._______._.Width of trench----�}!."---___________--. -. - n ib Type of filter material 4Depth of filter material____.f_$�______:_._.Total length____A o:....____•---_-•_______________ Seepage Pit: Distance to nearest well____ZD_a---------Distance fro""m�� foundation___-!.0 .........Distance to nearest lot line--->4 ___..... i Number of:pits_2— Lining material__. 6-.0 r__------Size: Diameter_._....1-'.........Dept h-----r .S,/...._ ' 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_____.._____.__...-.._...______-------. [] Distance to nearest lot line----------------------- ---------------------------------------------•-----------..._.__.--•--------•••-----------••--------•---------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------•------------------------------------------------------- ------------------------------------------ k -------•• ------------------••---------•--------•---------- ------•-------------------------•-----------------••--•----•--------•-•-----------•-•----_-----------------. -------------------------------- ------------------------..-----------------------------..._..•-------------------------------------------------------- •-------_..•-------------------------•-----.--. -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin CouI t ordinances, Sla laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ..._.. 1444-r" .--------(Owner and or Con+rac } gY� = t.:.- ., ---`----•------= (Tile)_` � (Plot .plan, showing size of lot..location of sys em in relation to wefts, buildings, etc., can be placed on revs side}. i " FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 10/4I00' DATEf 1 �(� '�-------------------------- REVIEWEDBY------------•---------------------------- - ---------------------------------------------------•---------------------------- DATE-----------------------------------------•---•-------------- >_ BUILDING PERMIT ISSUED-------------------------- ---------- --------------- DATE_---------------------------- ------ Alterationsand/or recommendations:---------------------------------------- ------•--------------------------------•-----------------------------------•-------- .............................. ----------------------------------------------------- ----------------------------------------------------------•-•------------•------------...-----•-------•---------.---__....------------------------------------ ---------•---------------- --------------------------------------------------------- i. , -------------•-----------•-•------------•----•--•------------------- FINAL INSPECTION BY,./0. ------ ------• .-_ Dat e.....4,�------ •----- ........ t� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 9th Street - Stockton,California Lodi,California Manteca,California Tracy,California II. ES 9 REVISED B-59 2M 5-81 ATLAS 1,