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FOROFF{�_E USE: -2 --------- _------ --------y APPLICATION FOR SANITATION PERMIT Permit No. ..._I-is ----- ------------------------------------------------- (Complete in Duplicate) ` t Date Issued ..Sy�lil. .L ----- ------------------------- -------------.--- This Permit Expires 1 Year From 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. 549, JOB ADDRESS AND L TPN_I A?--90_1 C Q �L� L� - $ • 1 Owner's Name...- ......... - = Com : �J on _- Address. "7.+ Contractor's Name.. _ Vrtment ` ,1 - ^ - PhoInstallation will serve: Residence 2-- A House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .1... Nu ber of bedrooms -Number of baths j.. Lot size -----��-'JC...-�-tP�__. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table `,/fit. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam [-] Clay dobe ardpan ❑ Previous Application Made: (If yes!date----------------17) No E] New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.) \ Tank Distance from nearest well.......---------Distance from foundation-------------.:._--.Material------....-----------...._._.............--.-___. No. of compartments..-------_ --•---------Size---•----------------------------Liquid dept-•---------------------.._Capacity-------•----•-....--� � -- rl` I sal Fi d: Distance from nearest well,&-9.Distance from foundation..-./0.- ---Distance to nearest lot linp--- ---gff_.... i Number of lines-------- ength of each line---- Q-�_-•--_--.Width of trench----sx i Type of filter material. - - epth of filter material--- Total length----. --------- ---------------- Seepage Pit: Distance to nearest well-W-QALA?----Distance from fpunda#ion.. .. ..:.......Dista ce;o nearest lot line..-.. f Number of pits---I-----------------Lining material-IKO-C-k----Size: Diameter.--- -- ------..:Depth-----Z.62�.........,___ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material...............----------------,_•--- ❑ Size: Diameter.-,------------------------------ -----Depth-------•-------------------------------------------Liquid Capacity_..-----------------------gals. i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- ❑ Distance to nearest lot line--------- -------------------------------------------------------------___------------------------------ --------------------------------- Remodeling and/or repairing (describe)-----_�j___� _ ----1.-..-_--__----- -- ------ --------------- -- y ;-- f ----....---•----------•--... -------•---------------_---•-•--------••-------••---------•-----------------••-•------------•--•-•-•----•--------•------------------ .....--•-------------------•-------- •-----•-----•-•---------------------------•----•-----------•:-------------.....-•----•-•-•---------------•--- -•---•-----------------------------------------------------------------.-----------------------------•-•--- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ( ordinances, St avj and rules and ejulation of the San Joa 'n Local Health District. I _�`1\JJC f (Signed).•.la �J sI�,� s�----------"- - t -+ --`"'- Contractor 1 (� ) By:---------------------------------------- ••-------------------- ------- Title (Plot plan, showing size of lot, location of system in rely to wells, buildin etc., can be placed on reverse side}. t ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- •C *- ---------------••-----------------------------.._ - DATE---------- ----------REVIEWED BY --------------------------------.••--- ----------------------------------------------------------------------------------- DATE................ --- •------------ BUILDING PERMIT ISSUED------...... — Df4TE_.- Alferation and/or ecommend'ons---------------------__-------..-------. ----_--_ -------- �. / •-•---------------------------- ------------------- -- ..........•------------------------------------------------------------------------------------------------------------------- I ------------------------------------ I ------------------------------------------ --------•----••---------------------- -------------------- ---------.----•------• - --------------------------•- --------------------------------------------------------------- FINAL INSPECTION BY--------------- --- - �.-. .- Date.------------------T/ 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 EB 0 REVISED 8-59 21A 8-51 ATLAS