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� OROFF E SE: ._------------------ APPLICATION FOR SANITATION PERMIT Permit No. ... �%- ------------------------------------- ------------------------- -- --------•------------------ - - AN (Complete in Duplicate) --------- -- Date 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. �s ee L JOB ADDRESS AND LOCATION--• ----fit S/Tl..t...._.�..5"�--•--•--•• ----•---- Owner's Name ! '----..�-A.- _e_,CM2 r= Phone. p 7!h 4..._,..�¢ 66tt... Address--....... t l l.2a�..... ----- -�...._...c7.S ...._.. ------------------ . �i9 X4:9 11--f------ Contractor's Name--•........... ..tl�r3'71...4,?----- � --- .._. Phone.:...:............................. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: .-/.. Number of bedrooms . _. Number of baths ._ . Lot size ... .......;L-.3.8'*e1&.... Water Supply: Public system 11 Community system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 21 Clay❑ Adobe)) Hardpan Previous Application Made: (If yes,date-----_--------------) No M New Construction: Yes J§ No ❑ FHA/VA: Yes ❑ N99 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welLYQ! -Distance from foundation-_-_.,l4_......M tenial......��t'�:eo...0.4/.......... No. of compartments________ ______________Size. X�- /3...Liquid depth__..______._--____--Capacity..-��..4'- i , a/ Disposal Field: Distance from nearest well/®.®...Distance from foundation.....ZA.......Distance to nearest lot I ..._.I........ Number of lines....._..._.___ __---y Length of each line____6!Q_.................Width of trench..... ,' ...................... Type of filter material......fCba -------Depth of filter material...../..........Total length__._.. '4�....................... Seepage Pit: Distance to nearest well___e��!•t-------Distance ftwn f undation.... .....Distance to nearest lot line..... 91 Number of pits........ .........Lining material.... .....Size: Diameter.....�„3..__.__.,Depth.......�,3.._............... Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material................................. Size: Diameter--------------------------------------Depth...........................................--------Liquid Capacity............................ Privy: Distance from nearest well----------------------------------------- _._Distance from nearest building 0 Distance to nearest lot line----------------------------------------------- .......................--..................................................................... .. Remodelingand/or repairing (describe):......................................................................................................................................................... ......---..•..---•---------------------•---.......---------------------------------•------•-------------------------------------------------------•--------•-------------------------------------------------•--•••--•-------- 'r ---------•---------•------•-----------------------------------•-----------------------------------------------------------------------------•----...---------•-----------•................................................. .n ..........................................--.................................................................................................................................................................................. 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 r ulations of the San Joaquin Locq Health District. Si ned 1�. ......Owner and/or Contractor By:._...•-... -- ''`-.............(Tide)......---•--•----•-•---••-•----------•••-....................•- (Plot plan, showing size of t, ocation system in re on to wells, buildings, etc., can be placed on reverse side). FOR DEPA TMENT USE ONLY APPLICATION ACCEPTEDDATE... ---- •• .. REVIEWEDBY---------------------------------------• --- ------ 7-- ._._ ..... ------------------------------------------------ DATE.............. ---••-•-•.................................. BUILDINGPERMIT ISSUED.......................................... -----------------------------------------••-• DATE............................................................. Alterationsand/or recommendations------------------------------------------------ -------•------------------•--------------------•-•-----•------•------------....----••......•-•--•-•-••-••-•-••. -•-•••••-•---••-••------•-------••-------------••••-•••--••••-•--•••••-•......-----....•••----•--••-•-•--•---------•-------•-•-----•--•••--•••••-•-••••-------•-•-•-•••••••---•-----•---••-••----•---••••......•--•--••••..... ---------------•---•-------..._..................................................... -------------•------------------------....-------------------•--•-----------------.......---••----------------....._......-••---........ f........................• --.....-------------------•------....--------------------.....-------------------•-----------------------•-------•---•-•--•--------------•---------------------•------••••....................... FINAL INSPECT ---- - -- ;.. Date_..----- SAN JOAQU 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 E! 9 REVISED 9.89 RM 8-61 ATLAS -1