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FUK UFFICE USE: ._ _. ------------------ -------------------•-----•----------- w __________________.__-______.___--_________- APPLICATION FOR- SANITATION PERMIT Permit No. -------------- ----------------------------- -------- (Complete in Duplicate) /� ^•<------ ---•----------- --- This Permit Expires 1 Year From Date Issued Date Issued .----._-_--�f ,_2 V7-- 2-Zo 2-o Application)is hereby made to the San Joaquin Local Health Distrfict for a permit to construct;and install the work herein described. This application is made in compliance with County Ordinance No. 549. � � D 8VK j1 A] JOB ADDRESS AND,bOCATI N - -Q _ RR ..` i Owner's Name..... ------ ----------------------------------- Phone-----•---•-------------------------- Address...-- b �. -Et.CALO Contractor's Name �^ D.?► �►�;`� ------ -------- :. /�,f -- P_ Phone . 3 Installation will serve: esidence Apartment House ❑ Commercial ❑]Trailer.Court ❑ Motel ❑' Other Number of ii.ving units: ......__ Number of bedrooms _��'.. Number of baths _Y Lot size __1-8_jA�i_ ...............:.......... to' . Water Supply: Public system ❑ Community system ❑ Private ❑ Depth t Water Table ........ ft. Character 4 soil to � pA of 3 feet: Sand M/Gravel ❑ San y Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hard an ❑ Previous Application Made llf yes,date____-.__.__.__-___l No New Construction: Yes Flo ❑ FHA/VA: Yes Hard an ❑ TYPE OF INSTALLATION,AND-SP1kCIFICATIONS:-�=- (No septic tank or cesspool permitted if public sewer is availableWithir 2bO-.feet.) 1��'6041' If � r / , Septic %< D*stance from nearest well 7 _._Distance from found -on____.� • No. :of compartments_ wfroz _Liquid depth_______________________-Capacity/, f& Disposal reld:i Distance from nearest well_ .-_Distant �undation..../V------.Distance to nearest lot line---j ... hi li JI W ❑ Number of lines........_ ... Length of each line___..-lam_ ;__ Width of trench.... .......................... Type of filter materi 1. D pth of filter material____..-,ff____ Total length_.._•.•__ ________________ 3 Seepage Pit: Disi#anc oto. nearest well----------------------Distance from foundation__..................Distance to nearest lot line----.------------ ❑ Numb--e pof pits---- _--------------Lining maferial----------•---------.-Size: Diameter------.------- --------,Dept h------•--•------ Cesspool: Distance from*neare.sf well_________________Distance from foundation--------------------Lining material-----------_-______-___......__..____ Sizer Diameter --- ----- --------Depth----•---------------------------- ---•-----------Liquid Capacity............. ---gals. Privy: " Distance.,froMTnearest well-_______________ _ - Distance,p,rom nearest building___-..-•-------------- -----------.-- Cl Distance to nearest lot line------------- - ----- ----------------------------k---------------- Remodelingand or re irin (describe):_____j. �l _ 3-_---_- �.K 1 ' I . . / p g i ] � QH. �t;N_i_._._._�('E =-..CI_ � ? ' -&: i�1:�4_._,9_S--=---- itlliv�l. -•-•--... It !�l !3ti � -y�' .-- ??F` RH?r1 FTS ----- it MONA }ate•laws, and rules end regulations li the San Joaquin Local Heald)-- •• in------------------------------------------------------ -__• r ifh ________ ___________ my I hereby certify that l have prepared this application and that the work will be'�'done in accordance with San Joaquin County ordinances, ' District. 4 (Signed)...- •-------------- -- -------------------------....---------------------------------------..,-._(Owner and/or Contractor) By:ls t--- _ ._.. .. •-- -- --- ------=--•-•----------------------------------•---•----(T'itle)----- --- --- - --- ---- -� ------------� (Plot pen, mg si o ot, location o system in relation to wells, buildings, etc., can be placed on reverse side). sr FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED [3Y---- --`--------------------------------------- ------------------------- DATE------- �-----J-/- -�_.�..-----•--•-------- REVIEWED ,B�Y------------------------ ---------_--------------------------------------------------------------------------------••---•--. DATE-------------------------------------------- BUILDING BY ISSUED-------------------------------------------------------------—------------------------------........ _ = Alt :w.. .� erations and%or_,em�,comendations:-._ - �.y -� - _....- .------- ---.... .----- lop t•54............. ................................................. -------- --4 - - ---- --•-•------•---.... -- - FINAL INSPCC`TfQN ---------. Date----------- .'1- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycomore Street 405 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.99 YM 5-61 ATLAS 1 .4