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FOR OFFICE USE: --- --------- ---------- -------- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._.�.�,lls1 (Complete in Duplicate) ________ _________________ ___ This Permit Expires 1 Year From Date Issued Date Issued7/ .4..- Application is hereby made to the SanJoaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. , JOB ADDRESS AND LOCATION-- i� A.r..At. `.! ! °--t- -�• t 1 --AddOwner's Name---- ------- ---- ----- --y-•-•• ----- - -------.. ...----------------------•-••---------------------------•---•�`----r.__.._. Phone........------------•----••--- --- Address............. ress-----------•.• l :..... •-•: ------------- X Contractor's Name------- Phone." _____._, Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer,Cou•rt ❑ Motel ❑ Other ❑ Number of living units: __1.--_. Number of bedrooms _'Y`Number of baths ..1___ Lot size ___________________ . .- - Water Supply: Public system ❑ t8mmunity system ❑ Private X Depth to Water Table ..._ --- ft. �y Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam, Clay Adobe❑ Hardpan-L] Previous Application Made: (If yes,date--------------------) No New Construction: Yes 6 No ❑ FHA/YVA. Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 f e Septi Tank: Distance from nearest well__ .1-Distan e fr m found i 7 ___-:.___..Materia__* Z-4._- ._...._.___- Rn No. of compartments..----..............Siz - a Liquid depth------ -- - ---- i- +p ty.. 1 1 .� *4 e t Disposal Field: Distance from nearest well.._-___._Distance from foundation. (.....- Distan`ce_to neares41oin ------------ Len th of each {ine � � ,Width of trench:.-- -•--.... -•------•--- !� (� Number of lines__S___..__...p� g �. �C Type of filter material.,_!_ __.�__a__ Depth of filter material..r «. ..__Total length...... 1_.. ..:- - 1 Seepage Pit: Distance to nearest well---------------------_Distance from foundation____ .........Distance to neo est.lo ElNumber of pits._.'.-_t----------------Lining material.....------------------Size: Diameter------------------------Depth--,----.-..-_--------...----...-- Cesspool: Distance from nearest well----------------- from foundation.__.77"�_ __Lining material-___-•_.__---__-___:._______--.--.--. ❑ _' -Y ' --------------------------- Distance ' --- �Dfstanceifromnearest buu�ildin~ V_^ ---- Size, Diameter----=----------- --------------•- Depth--------------------- ------ -- ------------------Liquid',Capacity.-•-••---- .-n�-gals. F Privy:; from nearest well______.____. 9 ❑ Distance to nearest lot line------------------------•---------------- g _I --- Remodeling and/or repairing (describe)_____________________________ �.�3.' ' -----------------------�i-•------•--------------------------------------•--• ----------------------------------------------------- ------------••-•--------- ---------------------•---•------------=------ --------•.......-------• -------------------------- 1 = + f a ----------------------------------••-------------------..,--------------------------------------•--------..---------------------=--•--------••--------------------------------------..-•-------------- ------ -------------- j,'.�.�..,...P . : . ,.:z -- ----------------------•----------------•---------•--------------------------•-------•-••--------------•-----------.._....--------..:.,1:.:. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I. s and rules and'.regulations of the San Joaquin Local Health District, t f �� (Signed) N-- s i Ss ned -._ (®�Ai . E ',;.� •ertdAor Contractor BY:. (Title} ._.._ .� ,, °......., (Plot plan, showing size. of lot, location of sy in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY T APPLICATION ACCEPTED BY--------------------------------- --------- DATE ------------------------•------------------------ REVIEWED BY-------------------------------- - -- - DATEr .�.. BUILDING PERMIT ISSUED---------- a .... DATE..-. ' ---- -------------------•---------------- Alterations and/or recommendations:-----------f•------------------•----------------.--------------------•-----...-.---------------------------------`_.-F-------- ---- --------..- , = -.--•-•---•------•-----------•------------ --•-------------------------------• --------------------------------------------------------- -••-----------------------------------....................... ------------------------------------------------------ -------------------------------------------- -•---------------------------•-•----- --------••--•---------•---••--------------------..-----•--•-•-------=------ ------------------------------......- ----------- ---- � '-------------------------•-----•------ 2- �r l �/ FINAL INSPECTION BY--------------------- -------------- -••--------------- Date...---------.-..,�----- /.-��,�7 - �j. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak Street 124 Sycamore Street 205 West 9th Street ` Stockton,California Lodi,California Manteca,California Tracy,California { ES 9 REVISED 0.59 2M1 5-61 ATLAS ' N