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'FOR OFFICE OSE: APPLICATION FOR SANITATION PERMIT Permit No. ---------- ---- (Complete in Duplicate) -- -------- Date Issued ---- -------- This Permit Expires 1 Year From Date Issued }Application is hereby made to the San Joaquin Local Health District for a permit to constructa n d 'nstall h rk herein �lescribd p This application is made in compliance with County Ordince No. 549. -Z 0—02— ...........------------------_ JOB ADDRESS AND CATIONS'69" ........ -- ---------------- . .. ...... . Owner's Name.-.----- --- ------- ---------------------- ---- ------------ ---------- -------------- ----- Phone.......... .•--- -- -------------------------------- ... .. !e 40 ---- - -- ------------------------------------.................................... -- ------ ----- ----------- Contractor's Name--- :..... -- --- ---- - ----- -------------------------------------------- Phone----------------------------------- Installation will serve: ResidencesApartment House ❑ Commercial E] Trailer Court [j Motel E] Other [3 Number of living un1T5;:;1%, umber of bedrooms . Number Number of baths Lot size ------------ Community system El Private Depth -ro Water Table?'O., ft. Water Supply: Public system [-I e X, Character of soil to a depth of 3 feet; Sand E] Gravel [-] Sandy Loam El Clay Loam [] Clay [] Adobe❑ Hardpan El Previous Application Made: fif yes date._.________________} No0 New Construction: Yes El NO19FHA/VA. Yes [I No' -f TYPEFOFLINSTALLATION AND,SPECIFICATIONS: f - . " 7 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) m foundation--------------------Material------------------------------------------------- Pk: Distance from nearest well__.._.__.______Distance from No. of compartments-_.... .Size-------------------------------Liquid clep�h---------------4-�-------•.-Capacity--------------_------ po I ie�d Distance from nearest well------- ---------Distance from foundation...................Distance to nearest lot line____......._..... Number of lines-----------------------------------Length of each line----------------------------Width of trench----------------------------------- *pr.,,k P" I 'e�cl: Type of filter material-------------------------Depth of filter material-------------------- -.Total length---------------------........_—----- Distance to nearest well/104--" '�__Distan e r fg)bnclaflon...,;�r ------Distance to nearest lot line 1/1549 Seepage Pit: ----------- ----------- Number of pits----p2-------------Lining materia --Size: Diameter-33---------------Depth----a.s- ---------------- ve,xsp 0 0 1: Distance from nearest well-----------------Distance from foundation--------------------Lining material-.-_-_-.--._.-----_-----___--_-_---_ ❑ aterial------------------------------------- 0 Size- Diameter------------ -------------- ----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------- ---------------------------------Distance from nearest building----- --------------------------------- f_1Distance to nearest lot line-------------•---•-------------------------------------------------- ---•-•----------•------------•---------------------------------- -- It Remodelingand/or repairing (describe)---------------------------------------- ----------------------- ---------_-------- ---------------•--=---------....---------------•--------------------------------I---------------------------------------------I-------------------------------- -------- ---------------------------------------------------------------------------- ------------ - ---------------------------------------r-----------------------�;---------------- --------- ----------------------------------------------------------------------------------------------------------- I ---------------------------------------------- -------------------------. ---------- -------------------------I---------------------------------------- ---------------------------- 1 here rti that I hpr rp`a` d this application and that the ork will be done in accordance with San Joaquin Count ordinance a awsn V , ' ve n egulations f the San oaquin ocal Health District. - -1 2 1 f (Signed --------------------- ------- er an rL ----- -------4--- - -------- ----- __�/or Contractor) By:------_----------------------7__ -- - - -- ----- -- ------- -- - --------- ............ :�- ----------------------------- (Plot plan, showing size of lot, location of system in rela e i dings, etc., can be,placed on reverse side). FOR b6ATMENT USE ONLY it APPLICATION ACCEPTED BY---------------- -- ---------- --- ----- -- ---------------------------------------- DATE-1-411 ---------- Vr__ ____ REVIEWEDBY------------------------- ---------------------------------------- I- ------- -----------—----------------------------------.,DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------ --------""r.." ---------------------------- DATE------- ----------------------------------------------------- Alterations and/or recommendations:-_-------- ------- -------------- ---------_--------------- ------------------------------------------------------------------------------- ------------ --� ------------------------ - --------- . ............... ---------------- ----lb------------------ ..............._Zi------------------------------ I `F --- --------------- 2_�p— -- ------- ---- --------- ----------------- ---------- - ---- - ------ —------- ----------------------------------------------------------------------------------------------- tc----- ----- ------------------------------ L ----.....................------- --------------------------------- ....... . --------------- -------------------- , M-------Wis.... - .-C ---- 66 FINAL INSPECTION BY:------ ----- -- f4ow 4- A/5 Dat -------------- ---------------_ -------------------------------------------- ------------- JO N L C TH DISTRICT 130 South AI 3 est Oak treat 124 5ycarnoro Street 205 West 91h Street Stockton,California µ Li,California Manteca,California Tracy,California ES-.'tP REWSED 8-59 2M 5-62 ATLAS