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R - -fi APPLICATION Ff�f SANITATION PERMIT Permit No. f .._ f ----------------•------------------------ -------------- (Complete in Duplicate) ----------------------------------- ---------_---------- This Permit Expires i Year From Date Issued Date Issued ' — � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATION.._....... _ Owner's Name---------- I ---------------------------•---------------..__.. ' ----------------4•---- -------:< .- _ ------ E Address_-..... f� #. •• ---------••--�•-------•--------•••--------•---•----•-----•----•---------------••-=------------------'---- :::_. Contractor's Name----- .... �::_ �{ = = =_==== =__---•-- ---------------_------ Phone......... s Installation will serve: Residence lam.' Commercial Apartment House ❑ l T I � .. ❑ -,� railer Court [—j Motel Othler ❑ Number of living units: .____ Number of bedrooms . Number of baths.___�__ Lot size .___ �_-,?�_. ----------------- Water Supply: Public system Community system ❑ Private ❑ Depth,tot ❑ Water Table -------: ft..a Character of soil to a depth of 3 feet: Send , Gravel E] Sandy Loam ❑ Clay Loam ❑ 'Clay ❑ AdobeD4 Hardpan ❑ Previous Application Made: 110 es ata-��g oQ1 No ❑ New Construction: Yes ❑ Nox FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION A SPECIFICATIO ». NS: •� �- (No septic tank or cesspool permitted if public sewer is citable within 200 feet.) Septic Tank: Distance from nearest well__-. ------Distance from foundation-------------------.Material-_____._-~____.._____....._ ❑ No. of compartments_._.....--.-a------------Size---_---------•-----_•---------Liquid depth----------------- - - Capacity t + - . -••.................... Disposal Field: Distance from nearest Distance from foundati ----------- •-- '__ _--Length of each line____.-___ [„ lW - ------------- -�-----•------.Width of trench...��--•-----•--••------•--- Type of filter mate'64 --Depth of_filter material..__% - ------Total length----------�.�_�-__------ Seepage Pit: Distance to nearest well----------------------Distance from 'foundation__._-_-.....:..._...Distance to nearest lot line------ -..�:' D Number of pits 1 Lining material -Size: Diameter------- -•-------------Depth------••-------------�---••---- Cesspool: Distance from nearest well________________ Dis#ante from foundation---.-----------------Lining materialEl _____.____._..._________. -----••---- - --------- p Deth--------•------------------------ Size: Diameter-----:i------•---------------- -------_--- Li --_--- quid Capacity ----------------------------gals. Privy: Distance from nearest well_________________________--____.___-___--.--_._Distance from'-nearest building '' r 9 -------------------------------------- Cl Distance to nearest lot-line--- �------• Re odeling and/or rep iring (describe):_ hS ne i .tor uin ordinances, State VOS. and rules and,regulations of the Sa Joaquin Local Healfh District. [Signed)_ -- ---- - ' .. ------------- •-------- - ------.(Owner and/or Contractor) By:.....................••-----------•••--•---- (Title)-------------- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). 3 FOR DEPAR MENT USE ONLY APPLICATION ACCEPTED B t - DATE.-_- -- I - - ------------------------------•-- - --------------------- REVIEWED BY__. = .---. DATE-------•--•----•---•- - - -------------------•-------•-- ----------•---------------------••-•--- BUILDING PERMIT ISSUED--- -------_----------------- — DATE Alterations and/or recomrriendations:_ ,,� _Irs -mg--- ,2.-k, ! -- •-•- ------ --- • -- x---.33- -•--,-r �:.. -- ------ - ------- •�F,�--l�� "T-. L�✓is-a-�. .�.fG•7,�I. a�. rte"�'-+4.. ,C!!�Yl+��•�-•-,' � U'+.T •,/ �- �..;_1 " '�� FINAL INSPECTION BY:------------ ----------------------- ------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak$treat 124 Sycamore Street 205 West 9th Street Stockton,Callfornia Lodi,California Manteca,California Tracy,California EA 9 REVISEb 8-89 ¢M 5-61 ATLAS - w � •��-yam