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R - --- �15E: _____________________ -------------/' - APPLICATION FOR SANITATION PERMIT Permit No. ..... (Complete in Duplicate) Date issued -------------- This Permit Expires 1 Year From Date Issued 1-Oe — 070-09 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install work herein described. This application is made in compliance with County Ordinance No. 549. S31IFG r__ SEc7_zaN- ,..� . JOB ADDRESS AND LOCA kON__---i-S1 �.-•l3 --54'G!_r_D!7 ffi "-""-"--•--- Owner's Name..�.!Y__ --------------------- Phone---------------------------.....--- ' -"-------------•-•--•---- .... Address..... = ..... '' €- Contractor's Name____L ��J ^«/t/ x -T � ,` / Phone Installation will serve: Residence U3-'Apartment---House ❑ Commercial ❑ Trai er Court ❑ Motel ❑ Other ❑ Number of living units: _ .._. Number of bedrooms 3_. Number of baths __l__ Lot size ._ � ��............................ .. z / . Water Supply: Public system 0 Community system ❑ Private [Depth to Water Table A2 eft. ..Character of soil to a depth of 3;tfeet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,dote_______--------------) No 23'- New Construction: Yes �No ❑ FHA/VA: Yes Rg— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well____��.JDistance from,,f�oundation---llP .........Material-&-i __f'��... .............. No, of compartments____.___.____ .__..Sizer �t�`J�__�1K kiel`Liquid depth____��__ ................Capacity.1,capacity-.1,409-450"..... Disposal Field: Distance from nearest well---gee%-------Distance from foundati n__/��___-_._Distance to nearest lot line__. ..... Number of lines______ _______ Length of each line__] _____ Width of french. -------------- Type of filter materieL4I D epth of filter material.../K, .._..-Total length----/a�__�_/_--------------------- Seepage Pit: Distance to nearest well_____ Q_ ._Distance from fou dation---��._._...Distance to nearest lot line._q _--.�.-__.- " Number of pits material... _ .0 _� ,�. �-__..____Depth_ ........................ p' g __�i__.__.Size: Diameter-22Y----__ Cesspool: Distance from nearest well------------r_!Distance from foundation..._---------------_Lining material.------------------------- ----------- ❑ Size: Diameter-------------------------------- -,Depth------•--------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well------------ -----------------------------Distance from nearest building---._.-..-_-____-_-_______________.____._- ! ❑ Distance to nearest lot line ----- - - ---------------- ------•------------•------------------------------- - Rertiodeiing and/or repairing (describe) R --- --"- - -- -------------•--•--•-•---•------------------••--•----•-••- ---- -------- -----------------•-----------••-•-----•------------- -------------------------------------------------------•-------------------------------------------------------------.....-----•---------------------•--•---"--------"-----------•-••---•----- ----------------- ----------------•---------------------•-------------------•---------------•-----•----------------•----------------------------------------------------------------•---•-----•-----•---••------.-------. ..----------- 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 of the San Joaquin Local Health District. (Signed)----------------�- --- ----------- --- ---------------------------- --(O�r Contractor) By----------------------------------------------•----------- ----- -- ------ --------------(Title)----O"� --`-•----.-..------.------------- (Plo+ plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on reverse side). A" FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY......a... . e�$-------------------•-----------------"--------------------------• DATE-•---�� REVIEWEDBY--------------------------------------------------------------------------------------••--------•-----•------------------------ DATE----------...-----...---•--"---""--•---------...__..._...-.- BUILDINGPERMIT ISSUED------------------------------------------------------------------"---------------------------------- DATE------••----•-••--------------------...... AFkeratiansand/ recommendations----------------------- -----"---------------------------•--"---•-•----------•-•------•----------.-----------•-------------•--p-------------•---------------------- �� i"._:.__... /� - �` --------- - ------�--•r— -r......C..h,.i r-------••----------------------- -----•-•-•---------------------------••--------•--------------------------------------------------------------------------------------•---------------•--..............._..----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------ ------•-•---------------------------------- - ------------------------------------ ---------------•------------•---------------------------------------------------- _..__.. --------------- --------------------- FINAL INSPECTION BY:..--- Date `.. .: Y tr. _. --------••------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak street 124 Sycamore Street 205 West 41h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 YM 5-951 ATLAS