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FOROFFICE USE: ?" I� -------------------------_-.--.---_----_--__..---...-.. APPLICATION FOR SANITATION PERMIT Permit ---------------------- - - -- (Complete in Duplicate) �j ]� Date issued .___.__... 7. / 1. ..__x__"`._. -- This Permit Expires i 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 O nance No. 549. -------------- 1 JOB ADDRESS AND LO TION... ......... Owner's Name------------ Phone• l� --------- -----•--------- ------ Address........................ ............. ..........................................-------- Contractor's Name.................... ••-- ------- -------•-----••----- ..............••-••- ......................... Phone----_------------•Ip............. ------------ - Installation will serve: Residence (� A tment House Commercial Trailer Court Motel Other B ` umber of baths .___-__ Lot sizeAAA-D Number of living units: __�_____ Number of bedrooms �N ❑ � ❑ I �I' -"''•'-=th to Water Table .Water Supply: Public system ❑ Community system ❑ Pnvate Dep � % I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ix Hardpan ❑ Previous Application Made: (if yes,date____________________) No)Rf New Construction: Yes,91No ❑ FHA/VA: Yes ❑ No .TYPE-OF-INSTALLATION-.AND SPECIFICATIONS:— - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep i Tank: Distance from nearest well-/ApD-_Distance from foun tion___-/40._......Mat ill_____} at .__--._.. V No. of compartments__---)�___._..____Size..�' .._,(__,&.....Liquid depth------- �___Capacity___, .` rDom. Distance to nearest lot e.lf............... Disppsal Field: Distance from nearest we€I-_../0istance from found �_ �! [� Number of lines-------- _._Length of each line_____�_�__--_._`,__..Width of trench____.Z.T..� -------------- Type of filter material _.Depth of filter material..._.A�.________Total length........�._�_,�_________________ 1 ' Seepage Pit: Distance-to nearest well----------------------Distance from foundation....................Distance to nearest lot line_--______-_-_-- I El P Number of pits_--------•---.._.---Lining material-----------------------Size: Diameter------------------•....Depth------------------ -------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--______--________--.............. El --------------------------------------Size: DiameterDe th---------------------------•----------------------._Liquid Capacity ......... ...----9afs. Privy:— �"= Distance1ram nearest ell-_-- ___________________ ___________Distance from nearest budding______ _________ ____I?___ w _._...... ClDistance to nearest lot line-------- ----•--------••--------��-/�----------------------•-•------••-----•-••----•-------••-•---•-------•-------------------- ------------- Remodelin , and/or repairing ,d scribe:_ "^�d� l� C1�`?�crr_-z .-T� -d---- - 0 --•-•_--•--•-Lc' .............. -----:-- 1 � - c '�~I - ------- 06------------------------- ............... i� ------- •---••--- - ---------- -•- ------------------ --------------------------------------------- . •----•-----•-----.--------...------------•-- ----..------------ --- --------------- I hereby certify -- that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statla an les nd regulation of a San Joaquin Iocal Health District. (Signed}Z--- -- ---------- -- -- •-- .. - --------------------------- --------------------------------(Owner and/or Contractor) B • t -�--= y - == __ = _ =- ... . •-- -------------------•..-•-•-•-.•--------•--------------------Ir+le} __.. -.............................- (Plo+ plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). I� FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------------------------------------- ---•---- ------------.------------------ DATE-•---------•---------_--- -------------------------------- REVIEWEDBY----------------------------------------------------------------------------------------- ----------------------- DATE------- '/ f.—C7 ^ BUILDING PERMIT ISSUED---------------------------------------- Df4TE--------- 'I Alterations and/or recommendations--------------------------------- ------ ----•---._.---•---•...----...---------------•-•--•-•-----------•----------.-..----.. M- ---------- --•--•-------------------------------------------••------.----•--------•----._-----------------------------------------------------•----------------------------•-•-----------.-----•----------------.--- ':-..--..-.-....- ,F I it ------•---------------------------------------------------------y---••-•--- -------•-----------•- ------•--•--•-•---...-----•---�---------------------------------------------------•------------ •--------------------- ------FINAL INSPECTION BY--------------- -/ r ---------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT �I 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California �I :l EB 9 REVISED 8-89 PM 8.61 ATLAS _