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fOR OFFICE USE: ------------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. .... .... _Go-7: --------- (Complete in Duplicate) Date Issued --- -6 V ............... -------- - 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&rdinance No. 549. 4,5- ,& JOB ADDRESS AND LOCATION...,_�---------m-------------------At ... ............................................................................ .......... .............. Owner's Name.----Iv+'t"t--- .................. ...................................... -------------------------------------. Phone---------...----------------....._.. Address................ -----------------------------------------------------------------------------------M-------------------------------------M--------------------------------------------- Contractor's Name--- -------------.577-5 ............ Phone................................... ..........................M------------------------------------------------------ ................. Installation will serve: Resiclenr_e4j' Apartment House [I Commercial [] Trailer Court 0 Motel 0 Other Number of living units,- Number of bedrooms Number of baths .1;n. Lot size ............................ Water Supply: Public system 4<Community system [:] Private E] Depth TO Water Table �G. ft. Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam 0 Clay E3 Adobe ET-Hardpan 0 Previous Application Made: (If yes,date--------------------) No 21 New Construction: Yes �No [] FHA/VA- Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic16hk: Distance from nearest well_________________Distance from foundationyho....... Material._-;a.................../......... I!r No. of compartments-..-a--------•-----..-Size.......VX_10X477,___Liquid depth__....-.'_._.______.-Capacity.. 94�.-Oq Disposal Field: Distance from nearesjell----—--___._Distance from founclation-10.............Distance to nearest Ic - 4S7.1....... 0q, Number of lines.._.._._ . ...... ----------- Length of each line2AI.r, 0 3l....Width of trench.__ -------------------- Type of filter mate rial-736-C,A---------Depth of filter material.-JIV-----------Total length_.._./��........-1.............. Seepage Pit: Distance to nearest well-- -'___-___Distance from foundation...P.-.........Distance to nearest lot line _.._...... Number of pits-----m2------------Lining materiarRAX.-t---------Size: Diameter-------'1 ----------Depth-.--_----AA7............. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material...._.......___.__................... El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well----------------------------------_----- - ------Distance from nearest building......... ---------m.m.................... 0 Distance to nearest lot line-------------•----------------------------------- --------------------------------_---------------------------------------------- Remodeling, andair repairing (ddescrie): -j; " -- -------- - --- -- -- -- -------- .. ...... ----- ...... ------ .. ..................................................................................................... ---------------------------------------- ---------------------------------------- ------M------M--------------M---------M-------------------------M---------M.........M-------------- 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 regulatio of t e San Joaquin Local Health District. (Signed)--------------------m.......................... ........ --- ----------------------------------------------- -----(Owner and/or Contractor) -- --------- - ------- ---------------------- By:......M......M-------_-----------M.................. ------M------------------------M--------(rifle)--------------------------------------m......................... (Plot plan, showing size of lot, location of system in relafio to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._j.-------4*4-10 ...................--------------- DATE.-- ...... - REVIEWEDBY------------------------------------------- -------------------------M----------------_------------ ----------- DATE----------------- ...........................-------------- BUILDINGPERMIT ISSUED----------- --------------------------•--------- -M..................... DATE------ .................................................. Alterations and/or race n)mend 9fions:.. ..... --------- /----------------------- ---------- ------ ------ -------------------------------------M--------------- .................... ------ ---------I--------M....................... ............. ...................M.....................--- ......... ..................................................... ................... ---------------------------------------------------.............................. ............M-......................................M...... ................ ............M------------------------------------------------------MMMM......... .................................... .........-------------------------M--------M-M..........M-------------- FINAL INSPECTION BY:./��... Date.... -------------m------ ------------------------------------------- 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 ES 9 REVISED B-59 2M 5-62 ATLAS