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rVKvrril.t u,.)t: ------------------------ ---------------------------- _________---------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ../ ....I. ----------•----------------- ------------------ --- (Complete in Duplicate} . Date Issued -------- ------------------------------------------- --- 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 'th Co my Ordinance No. 549. JOB ADDRESS AND LOC ON S VZ.V&----•-------- -- • ----------------------------------------------------------------- Owner's Name---------------------- d*4,.e_.°y__` -�-- ----- --------- --------------------------------------- Phone------------------------------------ Address --------- ---`------------•--- Addressrr•`��cY t• �. CLL�►_' " . .. ----------------------------------------------------.................................. 7 /'-- ...................... PhoneI _._Contractor's '.. 1C Installation will salve: Residence Apartment HouseT Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _______ Number of bedrooms A- Number of baths ._/___ Lot size -----(a ..._.• ----------------- Water Supply: Public system 0!rSommunity system ❑ Private ❑ Depth to Water Table 1f.vft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Say Loam E] Clay Loam ❑ Clay E] Adobe[Hardpan C1Previous Application Made: (if yes,date--------------------) No 19New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S i T IF: Distance from nearest well__Distance from foundation.___.-----Material................................................. No, of compartments-----------------------_Size--------------------------------Liquid de thW_________._._______-- Capacity c po alFeld: Distance from nearest well-�' one.._Distance from foundation..1.2._........Distance to nearest lot line___�.��.�. Number of lines_......l_________________________Length of each line____ ,_, !_____._.Width of french-------2.41'"__----------- ..�_IPQP d Type of filter material.%fj ,_R -.Depth of filter material-------ls?!*__Total length------- ----0.................. . �} Seepage Pit: Distance to nearest well----A_cA.G____Distance from foundation e �.___.Distan��fo nearest lot line__._®-•_ Number of pits......I______________Lining material..Rt��_____--Size: Diameter_ 3--------Depth.-_... `, _. '.______...... F Cesspool: Distance from nearest well................Distance from foundation-----------------__.Lining material------------------------------------- 11 Size: Diameter------------------••-----------------Depth-------•--------------------•---- ------------------.-Liquid Capacity............................gals'. (A Privy: Distance from nearest well---------------_--------_------------------------Distance from nearesf building------------------------------------------ El Distance to nearest lot line_______________________________ 1 O - -------------------------------------•- ,.� I Remodeling and/or repairing (describe)_-------------------------------------------------------- ................... C --•---•-••----•--------•----------------------------------------------------------------------....-..__.....--•-----------------------------------•-----------------------••---------•-----•---------------------------------- ----•---------------------------•-•-•-•-•-•------•-•----••----------•-----------•--•-----------•-------------------- 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.... ... ..I_ �C �Q `v.-�•r' ( #.••--- -------------`------------------••-•------------ Contractor) Y By:----------------------------------------------------- ----•---- -------- - - -------- -------------(rile).........i---------------------------------- - - - -------r (Plot plan, showing size of lot, locefion of system in relat' to wells, buildi s, etc.; can be placed on reverse side}. FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY..... __ __,____ - ---- Y ---------------------------------•-----...-------------------- DATE----- --�'-�-`��`--- ---��--�-------•_...'-. REVIEWEDBY------------------------------------ -------------------••--------------------- DATE-------------------------- -------------------- BUILDINGPERMIT ISSUED__.._....... ----------------------•------------------•--••---....-------------------------- DATE------------------------------------------------------------- Alterations and/or recommendati s: --- --- --- ------- - ------------ ----------- ---- --1- -•• --. .'Y ------ ----- -�---- .............•-------------------------------------..L------------------------------------------------------- ----------------------------------------------------------------------.-..-------------------------..-..------ FINAL INSPECTION BY:..�// __,__ -- Date � ^_.L_.. .-- --------------------------- SAN JOAQUIN LOCAL HEALTHID€STRICT 130 South American Strout 300 West Oak STroet 124 Sycamore Street 205 Wast 9t9 Stroef Stockton,California Lodi,California Manteca,California Tracy,California to 9 REVISED 8-59 2M 5-61 ATLAS