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FOR OFFICE USE: ------------------------------------------ -_---------- i ___.. ---------- ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ../.. .. , ----------------------------------------- -------------- (Complete in Duplicate) Date Issued ------r--�---�-v� � -- ------ --------------------------------------- --- This Permit Expires 1 Year From Date Issued 2c n Application is hereby made to the San Joaquin Local Heal+h District for a permit to cons rust a d install the work herein desc escrl ed. This application is madein with County Ordinance No. 549. ZD`7 l&, A!- p A V_ sT i , JOB'ADDRESS AND LOCATION--��cf� ---- "---hf.Gt ---------•---•------------ Owner's Name... .... c ------!6-- --- / , Phone Address---•----._....._r ' 4•�. +1�.... Contractor's Name.._1�. ..->"!^ ------------------------------------------------------------------------------------------------------------ ------- Phone................•--................ Installation will serve: Residence ]] Apartment House E] Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living units: ..!..... Number of bedrooms .3-__. Number of baths 4-____ Lot sizeAl"t-L-.7-4t________________________________________ Water Supply: Public system ❑ Community system ❑ Private El Depth ro Water Tabley'o__-. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam JN Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------_---------) No E] New Construction-, Yes, ] No ❑ FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`or cesspool Qe'rmitted if public sewer is-available-within 200-feet:)— Septic Tank: Distance from nearest well-.-4-A.-Distance fro foundation__/9-----------Material_ "I ............................ �] No. of compartments------�--------_--------Size__�1 ---- ---C---Liquid dap h-----y------------------Capacity,0 ,".__:-.. Disposal Field: Distance from nearest well.-Q_� _._Distance from foundation_!!?-"----------Distance to nearest lot ( Number of lines--------J---- ------- Length of each line....IN-0_................Wid -_ th of trench___S-_ -r_-------------------- Type of filter material. -- -- __Depth of filter material---i�`_-___-______Total length_aA-!0................__.._....... Seepage Pit: Distance to nearest well--- .,__Distance from foundation___- Distance to nearest lot line...fZ4. ..- Sl Number of pits-----A--------------Lining material_-_____...Size: Diameter_�A-----------------Depth----- ! !-__..._________---- i 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-------I------------------------------------------z------------------------------------ ----------------------------------------- Remodeling and/or repairing (describe)----------------------- ---------------- --=---=------------------------------------------ -------------------------------•------------------------ --------------•---•-------•--------•-------------------•-------•-------------------------------------------------------------------,---------------- -------- -----------------------------.-----•------------------� -------------------------------------------•----------------••---------•-••------•-------------------- •------------------------------------------------------•--•-----------------•-----------•-----------------------------Q 4 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 regulations of the San Joaquin Local Health District. (Signed)._ ��____ _.____(Owner and/or Contractor) ............._-------------------•--------------------------------------------------------------------------------------------------------------------(Title)----------------------------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__,4/'A ------------------------------------------------------------ DATE./ '. -- REVIEWEDBY............----------------------- ------------------------------•---------------- -----------------------------...--------- DATE-------------------------------------------------•--------- BUILDINGPERMIT ISSUED.---------------------------------------------------------------------------------------------------- DATE.-------------------------------- --------------------------- Alterations and/or recommendations:-------•-------- ---•-------------•-••----------------------•------•---- --------•--•-•--.-------------------------- -•----------------•--•- ---------------- ------------------------------------ -----------•--- ------------------------------------------------------------------------------------------•---------------------------------... ---------------------------------------•----•-•---------------------------------------------------------------------------------------------------------------------------•---•----------------------------------- ----------------------------------------------•------------•----------------- -------------------------------------------------------------------------------------------•---•--------------------------------•------- i FINAL INSPECTION BY: Date-_.- I_R_ -�!� _ • Q4 SAN JOAQUIN LOCAL HEALTH DISTRICT I' 130 South American Street 300 West Oak Street 124 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS