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"FOR OFFI E 'SE: 4 _ APPLICATION FOR SANITATION PERMIT 'tsmit No. • ---__ ---------+ -------------------------------------------- (Complete in Duplicate) --------- ----------------------------------------------- This Permit Expires "r Year From Date Issued Date Issued Application is hereby made to the San'Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in complianc``e,with County Ordinance No. S49. JOB ADDRESS AND LOCATION 1 __ _ __ ------•-----------------------------------•----------------•----.. .----- ---....---•••......•----•-•--•- Owner's Name-------- d ------�_,------ •...------------------------------------------- ------------------ Phone-----------------------•--•--------- Address------ --.S.2_0 9.e( = ---------- ---------------------------------------------------------------------•- ------------------------......................... .� Phone................... Contractor's Name___. _. _. •••••----•••- • -----•-----------------------•---------•-------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___I___ umber of bedrooms _3__ Number of baths __ �-�� Lot size . -•••---------•-----•-•-----••••••••- Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table 1A ft. j Character of soil to a depth of 3 feed Sand ❑ "Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes t-,No E] FHA/VA: Yes ❑ No 23-' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) v I Septi ask Distance from nearest well_________________Distance from foundation------------- ......Material________.._.._____........__...__.._________..... No. of compartments--------------------------Size--------------------------------Liquid depth--_---------------------Capacity...... ..----•--•-----•- it Dispos ie Distance from nearest well_____ ___________Distance from foundation.._____-._________..Distance to nearest lot line................. Number of lines.__1...-------••------------------Length- of each I•:ne----------------------•-------Width of tren,ch----------.---------.-------------- q ) Tpe of filter material..----------------------- of filter material-_______- --/____-___Total length_____,..._______.•---__________..-'_---- !^' See pa Pit: Distance to nearest well:_-.__Distant mrf9 undation -------------Distance to ned'rest lot line__---r...______-- v" Number of pits___.________________Lining material_P�YomS,ize: Diameter---r ._ .__-.__-_Depth_a )___.__________... Cess ool: Distance from nearest well_________________Distance from foundation...-_______-_______-Lining;material...______._____________---_________- P e-' _gals. ❑ '' _ Size: Diameter---------------------------------------Depth- ----•----1------•---=---------------------------Liquid�Capacity from nearest building Privy: Distance from nearest well----------------------------------------.._ g------------------------------------------ [I ------•=----------•----------•--------.❑ Distance to nearest lot,line------------------------------------------------------------------------------------------------------------------------------------------- - Remodeling and/or repairing Idescribe)------------------------------------------------------------------------------------------------•--••-----------•------------------•----------------•---- F ---------------------------------------------------..--------------------- ------ --••--------••--------------------------•--------�•-------•--------••------------ -----•------ I...-------------------------------------------------------- ---...__...---------------••-----•------------- -------------- -------------------- ---------------------------------------------------------------------------...---- ----------.-----------------------------------------------------•---------------------- I hereby certify that I have prepared this application a -that. a wor will be done in accordance with San Joaquin County ordinances, State laws, and rules and; regulations of the Sa oa Local ealth District. I --------------------------------* ---------------(Owner and/or Contractor) (Signed) --- -----------------------------------By:----•-----------------•---------------•------ --------I --- ---------- ---- - ------•------------(Title)---------------------- --------------------- - -------..-------- (Plot plan, showing size of lot, location of sys relat' to wells, buil ings, etc., can be placed on reverse side). FOR DEPA TMENT USE ONLY APPLICATION ACCEPTED BY_ ____-__ DATE___------ --�. . - �----- - ----`-��'-�f----- -------------------------------------- ---- ----.-,i....--- --------------- •---------- DATE-------------------------------- -------------------------- REVIEWED BY... --------i- •- --.. ------- DATE ---••- BU I LDING PERMIT_ ISSUED---------------------------------------------- - Al4erations and/or recommendations.---- _ _PZ� - .-•------•-------------- ----------------- ----- ---------------•-•-------•---------------------------------•-• -------------- -------------------------- ............... •-- -------•----•----.•-------------------•----------------------- --- + --------------- , Date------f._------..` — ---- -------------- --------------- ------------- ..,. FINAL INSPECTION BY------ --------- -------------- 111 SAN JOAQUIN'LOCAL HEALTH DISTRICT 130 South American Street 300 Wait Oak Street 124 Sycamare Street 205 wait 9th Street Stockton,California Lodi,Callfornia Manteca,California Tracy;'Colifornia I ES 9 REVISED a-59 211A 5-58 ATLAS . by.