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FOR OFFICE USE: ______________________________________________________ I h _---------------------------__-_-_-- APPLICATION FOR SANITATION PERMIT Permit No. -..� - ------------ (Complete in Duplicate} Date Issued _,:?_�:.�1_... '� ----------_________ __ __ .__..__.___.___ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a per tMo construct and install the wo herein described. This application is made in compliance with County Ordinance No. 549. / '� O5/- nZc0-CL-, %J ADDRESS AND O ON_U�_— _ _._ tf, ---•----- ��/ ., - ------ Phone-.--........... -----_------- Owner's Name------- - --- ---••-• --•-------•--•------- -•----------------- -------------- -----•-------•----------- y ,�pp �. Address C .rl'J.._ ,�.,__----- s 1;------ -----� .......---------•------------------------ __ ----- Phone_-------------------------------- Contractor's Name �... - '` - Installation will serve: Residence Apartment_ House,.❑t !Commercial ❑ Tr:ailef Court ❑ Motel ❑ Other ❑ Number of living units: __ __-fVumbt3r ofedrooms._ _ Number . baths,_ Lot size ;-__.�9_d.$! _ _--------------------------_...... Water Supply: Public system ❑ Community system ❑ Private e,Depih r�ater�Table _79. ft. Character of soil to a depth of 3 feet: Sand E] Gravel C] Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ -, Previous Application Made: (If yes,date__------------------) No New Construction: Yes.0 No ❑ FHA/VA: Yes ❑ No ❑ t I �-TYP-E_OF INSTALLATION AND SPECIFICATIONS: ( septic tank cesspool lP permitted Public sewer alewithin Zo feet.) Septic TankDistance from nearest well Distance from foudaoMaterial-----------_ l -------- Cl No. of compartments------------------_—----Size-----------------------------_Liquid de th--------------------------Capacity Dispos Fie7--1 Id: Distance from nearest well- _.._Distance from foundation--_____ _ _- �� __.Olstance to nearest lot li�e�_____ �� Number of lines----------/--------------- Length of each line------- ----------•----•Width of trench____o �I/.--•------------------� t Type of filter material... __Depth of filter material-------/g........Total length.......T Q----------------------------- 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___..________ ___......______..-q._f 13 Size: Diameter--------------------------------------Depth.-------------------- ----------------------------.Liquid Capacity---- -----------------------gall, Privy: Distance from nearest well----------_--------------------------------_-----Distance from nearest building r ❑ Distance to nearest lot line--------------------------------------------------------------------------•-----------------------==------•-----••----------------------x> R Ing and/or repairing.(describe):------------------------------------------------------ -----------------•-•----•-••---____-_-----------------------•-•-----------•----•-----------:'_ r -------'---------_..•--•---•----•-----•-•----•------------------------------------•-------.....- ------------••••-------•----------------•-•--------•----------------•---------- { ----- -------------------------------------------------------- =--- ________________________________ __________________________________________________________________________________________________________________________________________________________-------------------- ------------------------------------------- _______________________ _____________ ________________________-_._-____.____-__--.»__________-.---,__________._________________--._______________-_-_-____________________________________________________---._____.__---_._-_.»_.______--_.._._� �. I hereby certify that I prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, r �s and regul ' ns of an Joaquin Local Health District. [Signed] ------- ----•- -•---- ----- ------ - vrrter-qnd/or Contractor] BY: Title ------------------------------------------------ el ----- ,r----------_.�--- -- - - -------- ----I--------- --- -- --------•---•- - - (Title) (Plot plan, showing s e of lot, location of system in r etion to wel uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__1_169- - - - --------------------------------------------------------------- DATE---Io2r_-lfJ-�(0 7- --- REVIEWEDBY-------------- --------------------------------------------------------- ----------------------------------------------_.... DATE----------------------- BUILDINGPERMIT ISSUED..................-------------=------------------------•---------------• ---------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:---------------------------------- ----------------------------------------•---------------___---------------••--•--------}--------------------------------•--- ----------------------------------------------------------------------------------- ---------------------------------------------•------------------------------------------------------------------------- -----•------•--------. --•----------------------------------------------------------------------------• --------------------------------------•---.------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------•------------------------------------------------ --------------------.............................. -------------------------------------•----•--------------------------------••-•---•----------------------------------------•----•---------------------------------- FINAL INSPECTION BY:--� '.� ---------- 1 Date----/.'......h.� ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street134 Sycamore Street ter- 205 West 9th Street Stockton,California Lodi,California J mcir?teca!Collfornla Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS ' j I