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FOROFFICE USE: �r -------------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. .-t.�....�1-•_� -------------------- ------ (Complete in Duplicate) �� Date Issued ..... ••-_---•--•_.t ------------------------------------------------------__ This Permit Ex tree 1 Year From Date issued oro --5�j Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei described. PP p County e�No. 549` This application is made m compliance with Co�u�Oidinanc� � w — JOB ADDRESS AND LOCATION.... __.— I.11 -"---•--�r ...� ► ..L�© fib T... .f T . Owners Name....-----. .C1'� 1�---------L__t_....j.0.�_'_N--- ��iv =-----------------------------•--••------------._ Phone.-.,�=��— Address.......... -- - S Cf�LO'of Contractor's Name Phone - ----------•---•----- ---...-•--.- Installation w.IlAserve: ,.ResidenceApartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ l�"'"` ' �+r'"` t Number of baths./ Lots ee'. �.._.. = ..... Number of living units: _�.,__ Number of bedrooms _ ./ f Water Supply: Public syst&m ElCommunity system ❑ Private Depth o Water Table4ft. Character of soil to a depth"of 3 feet: Sand ❑ G a4el ❑ Sand --Loam.Eq�Cbay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ >I t Previous Application Made: (if yes,date------------- :} No New Construction: Yes ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: septic tank or cesspool.permitted if public sewer is available within-200 fee+.)� j -ej Se t1c lank: p Distance from earest well: Qistange prom fou dati _-� -_____._.M p No. of compartments____.______ � ..�--�.�--�---: -�---Eli uid depth aci f.��__.E.'..�. _____Size_.... q P. �� P tY-• -- P ll ,l_` _.__Distance from foundation__.... ..,__Distance toy iearest lot line-_.!= Disposal Field: Distance from nearest we / Length � _+1_p Width of trench___ !..................... Type of filter material_._ :!-C 14% Depthofffilter,mlaterialy.._. ---_______Total length______ ....__---••-•••------•-•- •� F Seepage Pit: Distance to nearest well-Y_ _______________Distance from foundation__..-___+__...__..Distance to nearest lot line------........... Number of pits----•------------ ❑ f--Lining material-----------------------Sizem Diaeter--------------------- �_Depth------.___-------••----------- Cesspool: Distance from nearest well----------------- from foundation___..._ Linin�a erial______.-__--______--._._____--_-----_ ❑ Size: Diameter--------------------------------------Depth-----------------------�`-- --- ----- ------Liquid Capacity----•-•-----•--•-•-•----•-••9als. Privy: Distance from nearest#well------------------------•-----•------------------Dstan�efrom nearest building----------------------------------------- ❑ Distance to nearest lot line--------------------------------------------- � �--'------ ------------• - -------------_-------------------------------- ------•-------------------------------•--•---------• ...-. .... Remodeling and/or repairing (describe)_____________________ s° i ,�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 laws, and rules and regulations ofJoaquin Local Healfhr Disfrict. L --- Ovner and/or Contractor)r -- - ------ ---•------ - _ ---------------------------•--•------ --------------------------:._...-,--------------------•---------------_-------------�Ti+le}---------- - --------- c., -- �..�; �; .� --------------- By:_ T -[Plot plan;iKowing size of lo+,-location o#-system to relation to wells, build gs,�tc., ca Abe placed on reverse side. A FOR DEPARTMENT USE ONL!Yr _,%6 APPLICATION ACCEPTED BY......... r -'- --- - _ DATE...'j = �.�-�/'1---------------------- REVIEWEDBY----------------------------------- '! ```.---------------. DATE--------------- --------- BUILDING PERMIT ISSUED....-----_---- ------------------ ---------•----------' --------- --r..rDATE Alterations and/or recommend'ations------------------------ 'f ---- ----------•---••-•---••---------------------------. -------- --------------------------- ----------------------------------.....-..------------------------••----•--•------= ----------------------------------------- ---------------. ---.._ .1----------------------- ------ - r ---------•---------------------------•-----------------.......---------------------._.... ..--•-- ------ -- --------------- -•-•-------...------�` ----- ------ - ------ --- --- ---- - -..- r f FINAL INSPECT1�hl— - Date ----------------------•- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED S_59 2M 8.61 ATLAS i f