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t - r FOR OFFI E.USE: = _ ---------- / 7 --- -- tlC^ Sr.. ----------------- -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...... ... _____________ (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 with County Ordinance No. 549, JOB ADDRESS�AND �LO ATION...... - -D D........ -- •----••-•---•----••-------------------•--_. i . ��G �__1_�__-_:Cl .- ... � . Phone Owners Name__ -._ Address �rC `.' -.....--•--- .. .------.................•----................................................•............... ---------- - -------- Contractor's Name... ►. Clr .__.. ..JVP Phone.._... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ........ Number of bedrooms -------- Number of baths -------- Lot size ..�_ -- Water Supply: Public system 2--c-'ommunity system ❑ Private ❑ Depth to Water Table _0t,* ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8--Hardpan ❑ Previous Application Made: (If yes,date-------------------.) No ❑ New Construction: Yes 0--go ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ppubriic�sJewer is available within 200 feet.)/ Se tic T nk: Distance from neares+-well-1�'°-�'`�__Distance from foundation._�-0---------Material.�r ......................................�. p� No. of compartment s{....C�-------------Size... . ---A�-- -----•-Liquid depth--- --------------Capacity t Disposal ield: Distance from nearest well-_�J___:Distance from foundation..c�•4...__......Distance to nearest lot line............ \ , / V Number of lines_____________________ ___ __ Length of each line___ Q-_. -.-------------Width of trench.____r�_��.._..;------------ Type of filter material. . ._. -Depth of filter material..__-9-�� Total leng+h__________________ ____ _ ,:�A..._...Dis ante to nearest lot line..._._5...... Seepage it: Distance to nearest well-?.dri'�-----_Distance f om� foundation___•_ -_ �t Number of pits__._.______________Lining material_ -r/'�---Size: Diameter_.__._ -..______-:Depth-____1•Q----._..----------.._ q Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.____._...______----_-____---..._-_ t C] Size: Diameter--------------------------------------Depth------------------.---------------------------------Liquid Capacity..----------------•........gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------.._--------..---..---j ❑ Distance to nearest lot line -------•----------------------------- ---------•---------- ----- •-----•-----------•----------------------•-----.- ----Remodeling and/or repairing (describe):-- '4 -- ----� � _4 -• ----- ------ ---------- 0 -A- - ----- - •---- -------------- _ ---•• --•------ a __41 - j -------------------------------------------------------------------------------------------- -•---------------- -- ------ I Bereby 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)--- U = --- •---- ---------------- -� { nor and/or Contractor) p ...... ... ----------------- By:--•••-•.....--•--•--•-•-'--••'-••-------'•---"-----_------------------- -�---- - -.._�--------- r-•, {T'itle)- -• -- i (Plot plan r showing size of lot, location of system in relation to wells, buildip s, etc., can be placed on reverse side). } FOR DEPARTMENT USE tbNLY f)_ APPLICATIONACCEPTED BY------------- ------------ ------------------------------ --------...--� - --- DATE..------- -1--------�.---.rte..-----------------•---- REVIEWEDBY------••--------•-------•------•-------------------------------•-------------------•-----------•--------- --•-- -------._ DATE--------=---....-------...-----.....------------------------ BUILDINGPERMIT ISSUED-_-------------------_:------------------------------------------_--•---------------------.... DATE------------------------------------.. ------•------------•- ` Alterations and/or recommendations- ............ ecommendations: ----•-- �I� � � .�----- - ------------------- --- ��._ -� ---off� --�-��-----�-�•-- -...---------••----------------------------------------- �- •-- -•------------------- •-•-•---------------------------••------------------------ ------------------- ----------- `f ' . _U.p�---��"' `(___i - ----- ------ - - -------------- --------------------- ---- FINAL INSPECTION BY:. Date- SAN T1 JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton;CafiFornla Lodl,California Manteca,California Tracy,California 4 E8 9 REWSCO 6-89 2M 5-61 ATLAS f