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FOR OFFICE USE: ----------------------------------------- ------ L� APPLICATION FOR SANITATION PERMIT Permit No. _.�:.:�................ (Complete in Duplicate) ' ° y ------....--------------r--- ---�-i--- ----------------- y t.—I . - - --- This Permit Expires 1 Year From Date Issued Date issued .........1_....: .:.' 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 AND LOCATIO N • --._. f Owner's Name... _ Phone...__ _-----_� .--- -- --------------------------- . Address----- .0 eL -----------------•-•---------••-------•--- Contractor's Name----- f�.�Q1Lt_---- ! --- --------------- Phone------------- ........ Installation will serve: Residence fiKApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - s Number of living units: ---/--- Number of bedrooms _,1-- Number of baths _J--- Lot size XjO_._14 _:---•______________________________ Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table 4X ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {If yes,date....................) No {` few Construction: Yes [�o ❑ FHA/VA: Yes ❑ No U--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S-ptic Tank:,, Distance from nearest well-----------------Distance from foundation--------------------Material---------------.................................. ❑ `) No. of compartments- --.. Size------------------ ------------Liquid de,th----------- - - ---------Capacity----------------------- W Disposal Field- �1 Distance from nearest well...!._.._Distance from foundatioyy -------- Distance to nearest lot,/line____.....• — Number of lines___________........... ......_Length of each line------- ___________..Width of french------��=i-�-___..________---. Type of filter material-_-- t _____.Depth of filter material--------__1-"-__.Total length-------$�o__---____________________ .' I Seepage Pit: Distance to nearest well-------- .-Distance from foundation____-�.'3------.Distance to nearest lot WNumber of pits-------/-------------Lining material__.y_y'_ZZZ...Size; Diameter____-+_5_r-.__.___.Dept h__..�:�?_.................. Cesspool: Distance from nearest well-________________Distance from foundation------------.-------Lining material_..______________.____-____________ ❑ Size: Diameter--------- ----------- -r----- -------Depth------ .............................................Liquid Capacity---------------- -------gals. Privy: Distance from nearest well----------------------------------------- . .__._Distance from nearest building..............._______________.._._.___--- ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------------------..... Remodelingand/or repairing (describe):------- --------- -- -------------- - --__---------------------------------------------------------•----------•---•----•--------------•--••-------•- -----------------•-----------------------•------------•-----------------------•---------------------------------------------•------------------..---_-------•--------------------------------•--•••------------------------ -----------------------------------------------------------------------------------------------------------•--------------------------- ------------ 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)----------------- ------ ._ 4,y, ----------------------------------------------- ----------------------- __-(Owner and/or Contractor) By: ----------------------------------------------------------------(rifle)---------------------- ------- ------• - -- ........ (Plot plan, ing s�t, 1+cation relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY...___... ._-..__---_____ DATE-----1__-/ _ 3------------------- REVIEWEDBY------------------------- ----- ------ DATE--------------- ----....._..--------------- --------._....-- BUILDINGPERMIT ISSUED------------------------------------------- --------------_ --------------- ------------------ DATE----- ----------------------- ------- Alterations and/or recommendatio s- ----------------- ---------- ------------ --------------------- ----------------------------------- ...------- _ C X � F --- ------------------------- -------------- 7 ? ry7� lel -C /`r' Cc- x .L, [ / 7=< c �� i� `�� __ L C c L E t. .... S L-L,/ c .( i�J--ci -- -�� E �_ --------------- 7. ------ f="� .. _ .. r � f ..:1 .z z L ..E��--.__.. Z� �t r-� -t - � -�f-- t _ .✓. 7' ` FINAL INSPECTION BY:......... - / -- •. . . ----_._. Date_... - - ------------------------------- SAN JOAQUIN 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 E8 9 REVISED S-59 291 5-61 ATLAS