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FOR OFFICE USE: 1 __ _5'_� ._-.lam-_.'�__ APPLICATION FOR SANITATION PERMIT Permit No. :. ---------------�--- --------------------------------- (Complete in Duplicate) y�� •� --------------------------------------- ------------------ I This Permit Expires 1 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 withf County Ordinance No. 549. JOB ADDRESS AND LO ON_. 1, 'l".._/_ s20 _ � .....�Y... ------------- Owner's Name ..... Phone.................................... Address ', r.l� = -- •----•--••------------------•---•---•- Contractor's Name................•-- -- tp ----------------•----•--•-----•••-•••----••--.....------•-••-....._. Phone................................... Installation will serve: Residence @R"-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ /Other ❑ Number of living units: ---.'l. Number of bedrooms Number of baths _!._- Lot size .hX.. .T.............................. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table LP�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Be-Vardpan❑ Previous Application Made: (If yes,date____________________) No Q' New Construction: Yes g3- No ❑ FHA/VA: Yes ❑ No 93-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SAptic Tank: Distance from nearest well___ "__ Distance from foundation----le---___.Mat rial..G%��:�� ............ 9?00^ No. of compartments-----A-...---_-____.--Size46KX_1'w__...Liquid depth--- ..--------.Capacity.."i Q...... Disposal Field: Distance from nearest well....."_-'-----Distance from foundation.... .._.Distance to nearest lot line...0......... UK Number of lines------- ------ ___________ _Length of each line...__ . _... _....Width of trench. s..._.._�................. Type of filter material./, _,Xj Depth of filter material-----lei___ ------Total length.._...1 . .................... Seepage it: Distance to nearest well-----._'. --------Distance fr m`f�o.undation.....Z&_....Distance to nearest lot line....X_`.... . Number of pits...... ...........Lining material..,/�pLei. ...__.Size: Diameter.�z.,�`y----------.Depth._Zr..!�............... Cesspool: Distance from nearest well-----------------Distance from foundation---._.______-..-__-.Lining material..................................... ❑ Size: Diameter--------------------------------------Depth-----------------•----------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building.......................................... ❑ Distance to nearest lot line----------------------------------------------------------------- --- ---••--------••-•-----••-•------------------------------- a go Remodeling and/or repairing (describe)--------------- > " -•---------•-----•-----•------............------............. -------------•--.----------•--•....................................................................------..........---...-•------------_-----•••-•--.----------•------------•-----.-••-------...-•--•-------•.._....------- ...........................................................•................................................................................................................................................................. 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 gulatio s of the San Joaquin Local Health District. (Signed)............. / � • •--•- ( vt Contractor) oe By:...............................................--------------- s -`-�---------lTitle) f - (Plot plan, showing size of lot, location of sys+ n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY., - --- � --------------------------------------------------------- DATE--�'_--��---7 --•------- REVIEWEDBY--------------------------------- --.-_-------------------------------------------------------------------------------- DATE........................................................... PERMITISSUED..............................................................--------------------------------------- DATE............................................................. Alter ations and/ r re orr1mendation ..V_1-------------------- `-"� l = '__,7r a�--I""--- I k- F1c��` --- �.-1,at ------v.- .'--••--------------•-•--••••-------------•---••-----•••--•- -----•----•----------------•----------------..._..--•----•-...------•--------------- ------------------------I................. ..........-....---...............................------------------------•---------•------ ------------------------------------------------ ---------------------- ------------------------------------------------------------------------------------------------ ---------------------------------- --......---- FINAL INSPECTION BY:------ ---------------------- Date........ __ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California - Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 2M 5-61 ATLAS