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FOR OFFICE USE: ------------------------------------------------- ---- ______________________ _____________________ APPLICATION FOR SANITATION PERMIT Permit No. ...f. ... ._ ------------------ '-�- - -------- ----- --- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .--`1. �0......... 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...loo..40------IL..................... Owner's Name.................................. 1 •- 11 71F 's1 Phone _..... Address--------------------------------- - ........................................................3.. I. i.............. Contractor's Name---no-UT..&_ "It" 1 --,U11"I- Phone---- - ------ Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ....& Number of bedrooms _ ..X4umber of baths_- Lot size -.32.00...X---la5l.......................... 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 al Clay Loam ❑ Clay❑ Adobe❑ Hardpan❑ Previous Application Made: (If yes,date--------------------) No a New Construction: Yes (I No ❑ FHA/VA: Yes ❑ No Q TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /ZOO Sceptic Tank: Distance from nearest well %#------Dis un ation._.. �" ' l�° – Material r No. of compartments---------a ------------- ........Liquid depth___... _Capacity.. :. ►'fs Disposal Field: Distance from nearest well ._Dis a from foundation .._._pistance to nearest lot line ..s� Number of lines----- -----------------------Length Aoe�cc ffn,,;y° _._._ Width of trench.__.__.. 3 ... Type of filter material._ epth of filter material------- __--_-Total length...... �� Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line.................. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter........................Depth_..........._____................ Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material..................................... ❑ Size: Diameter-----------•--------------------------Depth----------------------------------------------------Liquid Capacity-----------------------....gals. Privy: Distance from nearest well______________________-____-_-________.________Distance from nearest building.......................................... ❑ Distance to nearest lot line---------------------------------------------- ------------------------------------------------------------------------------------------•---- Remodeling and/or repairing (describe):_-------------------------------------------------•--------------------------------•---------•-------------------------------------------------....... -----------------------•---------------------------------------------------------=--------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------•---•-----=-----•------------------------------------------------------------------------------------------------------------•---••------------------------------ 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 regulations of the San Joaquin Local Health District. (Signed)....I)*.- ...AAM..... --- Contractor) By:------------ --------------------------------- ----.-------•--------....-----•. -- -- r-.t (T'itle)----------------------------------------- -------- (Plot plan, showing size of lot, location of system in relation tow IIs, buildings, etc., be placed on reverse side). FOR DEPARt MENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------------------------------- y DATE G�_-� ... - REVIEWED`BY---------------------------------------------------------------------------------------------------- ----------------- DATE............................................................ BUILDINGPERMIT ISSUED..............................................................–...................................... DATE............................................................ Alterations and/or recommendations:----------------------------------------- ----------------------------------------........................................................................... ........................ ----- ............................................................. •--------------------------------------------------------------•-------------------------------....---------- f0-^�� EF�►B '7�4nt '` = Ri o ...GA_4-,Ls............................... ----------------•---•----•---------- ......................---- --------------•-------------- -------------------------------•--------------------------------------------------------------...----- FINAL INSPECTION BY:..-. - ----------- Date------------- .(......------------------------------. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wort 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-61 ATLAS