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FOR OFFICE USE: > _ ---------------- - v -------- --------- APPLICATION FOR SANITATION PERMIT Permit No. . - •-D-••-•- • I -------------------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued �} , -- Date Issued -------------------- f ----- --- -- � II i hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I Application s he e y q � This application is made in-compliance with County Ordinance No. 549. JOBADDRESS LOC TIO ;-- .. ..-�_!___- --•-•-- -------•............................................................................. Owner's Name---------------- -• ----------- - -------------•--------------•-------------------•--- Phone.... --r--.__...� V. Address----•--------------- _> -�•----I--- v ---- -• .. •--• --- --------- Ph••-•.........-•-----•• ---------•--------------------- one Contractors Name - "' -- - -- ----•-•••---'-'--'- Installation will serve:. Residence (l-impartment House ❑ Commercial Trailer Court [I Mote! [3 Other ❑ f i� 9 I Number_of living units: �__. Nuimbe� of bedrooms -[ `:_ Number of baths __ Lot size'..::-" -..y - •••-- = Water Supply: Public_ system [ �rommunity system ❑ Private [-].,'.,Depth to:Water Table'��.,ft. t..1 Character.of soil to.-a depth of 3 feet: Sand ❑ �Gravelu❑ Sandy Loam ❑ Clay Loam ❑ 'Clay❑` Adobe M-; d an I] ' Previous`Application Made: (If yes,date-----------_________) No New Construction: Yes ❑ No 2--€HA/VA: Yes ❑ No ❑j TYPE',OF INSTALLATION AND SPECIFICATIONS: (N septic tank or cesspool permitted if public sewer is available within 200 feet.) k c 'a N Distance from nearest well________________Distance from foundation__._________._..- Material______...___ __._._. No. of compartments---------•-• ----------•--Size---•----------------------------Liquid depth--------------------------Capacity--•-•----••--•---....l0 d. Distance from nearest well------ Distance from foundation....................Distance to nearest•lot line.................. Number of lines------------___________________---Length of each line..--_-_____-_________;__. Width of trench:______.--_-_-______.__----._____-- Type of filter material___ --- Depth of filter material________________(•__Total length___..--_________------_________-.------- Seepage P' : Distance to nearest/ell-_ : _� Dis ante fr f ndation___ Q___--__. istancee o nearest lot line...s__.....� Number of pits....____________.Lining materia _ :.Size: Diameter_ De"- p -- - ti th---- --------•-- Cesspool: Distance from nearest wail_________________Distance from foundation_-_________________.Lining material------------- ' ❑ a 10 Size: Diameter--- _ - _--_ Depth------- -------------------------------------------- 1 Li uid Ca act� s. --Distancefrom nearest building -•---• -•------------------Privy: Distance from nearest well r ' ❑ Distance to nearest lot line----------- ---------------------------------------_-------------------------.•-•---..-----------•----••--------•-------------•-------------- y Remodeii - ing and/or repairing (describe: .............----------------------------------------••--------------•••-•••-----------••-------------------•------------•- :.... ---------------------•----------------•---------•-• ---------••-•--------------------..-..-----------------------------. -----------------•-------------------------------------------------....------------------- ------------ �M herebycert' that I have prepared this application and thatthe work will be done in accordance with San Joaquin�C y ordinances t I s,St rul s and regula ' ns of the San Joaquin local Health District. I and/or Contrac n - - --- ner tor). (Signed) Title - By=---------------------------•---- ( } (plot plan, showing size of lot, location of system to relation ti_� ls, buildings, etc., can be placed on reNerse side). FOR DE RTMENT USE ONLY APPLICATION ACCEPTED BY_. ----------------------------- DATE----- �----------------• ------ - REVIEWEDBY__..: = •--•--- -----------------------------------------------------_- ----------------------------- DATE.-----------------_--.................................... BUILDING PERMIT, ISSUED-----------------=-------------------------------- - - .- ---- ss..---- DATE----------------4-- ------ -= dj�_--•-_--- 'I Alterations'and/or recommendations:"�__�`-°�=:-_�2_..__-___�.__._.__}lti � I�, � -• ..............•. -•--�.��.�-:.--------=-------- ------------•---•------------------------•-•------------------------•---------------•----------------- ----------------i-- ......-•---------------- --------- ------------------------------------- --------•-------------------- --------------------------.-..------------------------....•------------------------------------••-I.............. � -••--•---------------------------- --------------------------- ----•---------------------------------------------------------------- - FINAL INSPECTION BY:.--- ---------------------------- Date---8-^!-t_'. ° - ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Weil Oak Street 124 Sycamore Strut 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 RM 5-61 ATLAS II