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`r,---- FOR OFFS USE Permit No. 1.. �I APPLICATION FOR SANITATION PERMIT - I --- ---------- --------------------- ----------- ------- ---- (Complete'lin Duplicate) ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued I Application is hereby macl4lto the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made 1n compliant wi h County, untag OOrrddinnance Nq. S49. JOBADDRESS 3AND-4,VOCON---- ----A----- � 7�� _..----•-----�,�?�c. -_-------Owner's Name--- -•---- -----Address.-•-----....-- - ----- ............................................••-----•---------------------------------------------------------------------------------.................. ._.. Contractor's Name.......... I. ----------------------------------------------------------- Phone................................ X Installation will serve: Resi' once `Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living unite: .�.._.. 1Number of bedroomr�__ Number of baths .-/___ Lot size��-)C7S:�4._1S'D__ C�__-X_7ii2._ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe1kHardpan ❑ Previous Application Made. (If yes,date--------------------) No)<r New Construction: Yes El �4- FHA/VA: Yes ❑ No TYPE OF INSTALLATION . ND SPECIFICATIONS: # I I K (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4ispop tic r Distantly from nearest well_________________Distance from foundation------------_-------Material-------------------- .__.._........--------------- h. No. of('cIompartments------------- ----�.-Size ----------------------- depth--------------------------Capacity_...----•---•.... l Field: Distant from nearest well___-___,-Distance from foundation-f- Q___..._Distance to nearest lot lie-.�._...... Numberllof lines_______ ___________ ength f each It . Width of trench------—, d ---Y-------------•-- V flter e ----------------- - Length ------------- otal length of. m - lteof filter material.. .............. V Seepage Pit: Distance to nearest well-- - --------------Distance from foundation....................Distance to nearest lot line......_.......... NEl Numberhof pits----------------------Lining material--•----.-.-----_ _ --Size:;Diameter----_----------------- Depth---------------------------------- t Cesspool: Mstancill, from nearest well_________________Distance from foundation___ ----------- material------..____--_.__................... �1 ❑ Size: Diameter Depth--•----------------•-------•-= -------=-- Liquid Capacity gals. Priv Distance,. from nearest well______________________ __-_Distance from nearest building ❑ Distan4 to nearest lot line------ ------------------------------------------------•--•-•-----•------•-••--•------••-------•----------------------••---- --------- �I ------ Remodeling and or re airiri describe :._ aL�sr-rz.c.rE.�_ _ __ l `' �I ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ----------n------------•------------- I hereby certify that I ihave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, SFinga ws, d. rul s a regulations of the San Joaquin Local Health District. ;��a (Signed) ---------------------------------------------------------------------- - ------ ------ - --------------------- Owner and/or Contractor g )---------$Y• -= l--------=--- ----•----------------------------------------------------------- (Ti+le) -------------------•-•-----1n-..---.. -•---- (Plot plan, shsize of lot, location of system in relation to wells, buildings, etc.,'can be placed on reverse side). lip .. ✓ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDh BY------ --------------•- --------- DATE--------��--1.�-G_._;------------------- REVIEWEDBY------------ `.. �a = ----------------------------------------------------------------- = DATE--------------------------------------.............. BUILDING PERMIT ISSUED�� ......... .......•--------•----•-•----------------------------------•- ........ DATE------------- ------ Alter tions and/or recommendations:�-�-7 2___.�. C . el --F� al -------------------- ----------------------------------------------------------- ----------------------'------------------ - - - ---- -- -- -- ryl t FINAL INSPECTION BY.:. ------------ . .. . . Date-------5 . ---- -- --- -- --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak STree1 124 Sycamore Street 205 West 9th Street Stockton,California I Locil,California Manteca,Californla Tracy,California I HS 9 REVISED 5.99 2M 5-61 ATLAS'„I(':