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FOR OFFICE USE: ---------- ------------------------ ----------- ----------------------------------- -------°- ----_________________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. . .lu S.... -----------4--- ----t (Complete in Duplicate) // ? --------------- (---!-- -----------------.--- This Permit Expires 1 Year From Date Issued Date Issued ..��: .Sa.'�a 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 LOCATION--•----- - -s _..ae;Z;6+ Q---_--------------------- �o'.f'/%! - Owner's Name------ �'f/`I1,1'V 4015L. ----- - ------ -- --------------------------------- ------------------------------------------.- Phone.._.!`Z_U - ..... Address............................�.i. art .. -----------------•------•----------•---------------.----------•-----•----•--------•-----------------------.-------•----•----...._......--•.. Contractor's Name----------6-e-V— {4A--- --------•---•---•--•------------------------------------------------------------------------------------ Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...... mber of bedrooms J3 Number of baths -----I- Lot size ..... Water Supply: Public system N Community system ❑ Private ❑ DepthWft �To ater.Table ........ . Character of soil to a depth of 3_feet- Sand E] Gravel [-] Sandy Loam El Cl ay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: qIf yes,date____________________) No ❑ New Construction: Yes [Er No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Qa t c T nk: . Distance from nearest well-- --------------Distance from foundation....................Material........................................ ......._.\1 No. of compartments--------------------------Size-------------•-••....-----•.---Liquid depth............. ------------Capacity..... ................. v Dispos field: Distance from nearest wel. Distance from foundatio .......Distance to nearest I�fr 1Numberof lines__._...._._. !__ _._.__ •.-_: Length of each line_____._. _�-----.Width of trench.__.._w . .............Type of filter materia Depth of filter material-._.��______-___-Total length..........41 . . ._........_..... See Distance to nearest wel__--.________________Distance from foundation....................Distance to nearest lot line................. Number of pits----------------------Lining material---.----------..------.Size: Diameter.......................Depth................................. Cesspool:. s Distance„from nearest well-----------------Distance from foundation__._._----.--.---_.Lining material..................................... Sized biameter-------------------------------------De th---------------------------- ❑ P ----------------------Liquid Capacity............................gals. Privy:'` Distance from nearest well------------------------------------------_.-_Distance from nearest building----------------------'1................. ❑ Distance to nearest lot line-----------•-•--------------•---------------------------------------•---•--------------••----•--••----•------•-------------•---•-•---•-------- Remodeling and/or repairing (describe):......................................................................................................................................................... --••-------•-------------------•--•-----•------•-----••-----•----------•------ -------------------------•---------•-••-•--------•-----------•--•-----•-------- ............................................................ -------------------•----...-----------------=•-----------......-------•---•--------•-----•------------••--------------------••--•----•-----•-----•...----•----- ............................................................ -------------------••-------------------------------••-----•••----------------------------•------------------•--------------•--------------•-•--••-----••-----------•-------•--......----•--•-------- --------------------- I hereby certify that I have preMiplication and that the work will be done in accordance with S4 fwJoaquin County ordinances, State laws, and rules anhe an Joaquin Local Health District. (Signed)-•-----------------------------•--•-•---. . '1 --- (Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Title)--------------------------------------- 'f --------- (Plot plan, showing size of lot, location of system in,relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....----- r-----2--'e'e--k-------------------------------------------------------- DATE------....7 .................... REVIEWEDBY------------------------------------------------------ -----------------------------------.................................. DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED_-------------------------------------------------------......................................... DAT, ............................................................. Alterations and/or recommendations:._.___.__-.___� - G_�- -:.... ..�-Ea _ �i�.I�=- . — � `--_ ---- y� . -------- ---- 'F fiy�. .............. .. --••--..:!! ....................... -`: ... y'_t'p.. �-e�---'��.........e - _----�'----- --------------- -C • ,_---,...................... ---•t=}•r' - =!` _!_�i..7_-, ............................... ----------------------------------------------------- ------------------------ ------------------------------------ ------------------------------------------------------------...--•-------- ---------------------------------- ------------------ - ------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:..----------------------------------------------------------- Date-----✓f --�..�---�-�-•�---- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 SoutlrAmerican Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manftc`a,California Tracy,California i ES 9 REVISED B-59 2M 5-62 ATLAS