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FOR OFFICE SE: .. .7 _. 10 APPLICATION FOR SANITATION PERMIT Permit No. ... �.... --------------------- � (Complete in Duplicate) Z- __._.----.'I_- Thi Perm Expires i Year From .Date Issued 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 Ordinance No. S49. i� p JOB ADDRESS AND LOCATION...gF101-..... 1_...�k -----•-•.........:...............••-------- f , I. Owner's Name-----------A ........----------- -•- Phone.....................•............... Address--------- fi �A= -----------------------------------------•-.-- -•-----------.-------• ---- -----------------------•-•----•---•----------------•-------•...Contractor's Name.. , , �C ----_---------------------•-------•----.------- ----------- Phone................................... Installation will serve: Residi'nce g3-Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of living units: --- Number of bedrooms _1. Number of baths -9-- Lot size, e. ---- ............................... Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table AP.Oft. Character of soil to a-depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe eg-llardpan ❑ Previous Application Made: (If yes,date--------------------) No Er New Construction: Yes g;.-No ❑ FHA/VA: Yes R;.— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) € Septic Tank: Distance from nearest1__:" "---__Distance from foundation-_A9--------- .. ................... No. of coJmpartments--- ------------------Size. � > t ` °�iquid depth-----�( --------------Capacity./,W ....... Disposal Field:_ —Distance from`nearest well..--- --------Distance from foundation.->./A7 A7°.....Distance to nearest lot line_.--_-_•- [� Number of'lines._..J...._..--_--- Length of each linV�W_..g9�_.d �4..Width of trench._a.�........................ I Type of filter material ,Depth of filter material-- ^r_- Total length-_--.2_' f.`. Seee Pit: Distance to nearest well-------------- -- Distance from foundation-----------------...Distance to nearest lot line............ ~' Number of.pits----------------------Lining material-----------------------Size: Diameter......................-Depth-----------------•--------------- Cesspool:: Distance lfrom`nearest well-----------------Distance from foundation-.----------_--..Lining material..-------------.----,- --:----_--._--.- ❑ i ee _ � , . r ------- _ -------•-------------- -----.-Li_uid Capacity gals.Duma# r. : `_�"''�VDpth------------------------ ,I Privy: Distancefrom-1 nearest well------------------------------------------------- from nearest building------------------------------------------- Distance to;near estlot line-- -------------------------------------•----------------------------••-•- ------=- ...- - --------- ---------- Remodeling and/or repairing (describe=--------------- - . :. I i i t -------------------------------------------•---- i = .� 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 r ulations of the San Joaquin Local HtaaltFi DistFict:"" - (Signed)----------- `' -----•------ _ ----------•-----•-------------E----.-. r Contractor By:' (Title)- '-----••--= = -------------- Y•••...-•-•-•--.........4 .....- (Plot plan, showing size of lot, location of `ystem_' wells, buildings, etc., can be placed on reverse side). TFOR.DEP ARTlv}'ENT USE ONLY - n APPLICATION ACCEPTED.BY 0- 'i� DATE -=---=: '----------------------------- REVIEWED BY.. ---------------}-------------------- --- ---------------- DATE------------------v'--------------------------------------- BUILDING PERMIT ISSUED---...................... _--------------------------•----------...---•----•----------------------- DATE.....=-----------------`'-=-- ---------------••-•---------- Alterations and/or recommendations: 4--.... =`. -:___-------------•-----.....--------------------------•-•---••'---...------.....-y------------------........_...---- F --�------------------------------------••-----•------- III �.� _`�.. -------•--•----.------•----•-•---------- -•----••-----------._..-...-•----•-•----•--;-------•-----•--•-•----------•................•--------------------- --.....---.........------•...------------------• I--------.....-....----------•-------•---------------- --•--------------•---..... --......- -...-........ _...-----..........._-..-.................---•------------ ------------------ ...................... . ..................... .r ii FINAL INSPECTION BY:.' ... ---------•-•- •..... Date... "== - ....................----------............ �4 1 SAN JOAQUIN LOCAL HEALTH DISTRICT '^ 130 South American Street 300 West Oak Street qN43_ 124.5ycainore Street}�.) 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EE 9 REVISED S-Sg yM 5-61 ATLAS 7 �' II