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rVICllrrlLC ----------------------- -- J - 1 APPLICATION FOR SANITATION PERMIT Permit No. __.1_�Z........� ----------------------------------------- --------------• I (Complete in Duplicate) --------------- ------------------------------------------ .�, :S L --------------�-�- } This Permit Expires 1 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. This.application is made in compliance.with County Ordinance No. 549. 2S0 JOB ADDRESS AND LOCATION-- 7!Q/7� f'..-,i*��Fl/ ,� � a �'p Owner's Name-------------- Address........................�..,,5��1J7��' ----------- Phone 7':F___4/ -• - -•-----------------•----•--•-------•---------------------------- •-• -- ---------- ----------------•------------.._-----.----- ----------•----•--------------------•---•--- Contractor's Name---------.-:�i..�� ,1 r } Phonr.��,Qr�J-•--- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of livingunits: _- - Number of bedrooms _-�_-- Number of baths _, Lot size _:--- --- • ............ Water Supply: Public system ❑ Community system ❑ Private �epth to.Water Table':��ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand •Loam Cla Loam I Y ❑ y Olay ❑ Adobe❑ Hardpan ❑ Previous..Application Made: {If yes,date-_-----------------) No R' New Construction: Yes e-No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} } Septic Tank: Distance from nearest well--- -�----_Distance from foundation__.-,�-1.___.Material-_------aN............................. { r ., No.,of compartments---------2------------Size__We d >� '.Liquid e+h-----T '-----------Ca aci /K- p tY--.0Cf.. Disposal 1=laid: Distance from nearest well-----------------Distance from foundation---------------------Distance to nearest lot line......-.......... El �y� / Number of lines-----------------------------------Length of each line '------"`----"---' .-:"Width of trench=-------•---------------• Type of filter material-------------------------Depth 'of filter material-----------------------Total length------ ----_---..--.----------_ Seepage Pit: Distance to nearest`wall ----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits----------------------Lining material---------------------Size: Diameter----=_••---..-..----..Depth------•-•-----••--•-----••----• .. Cesspool: Distance from nearest well................Distance from foundation-_-_-------.-_---.Lining material----.---.._..-__---....- -••-•-•----- ❑ Size: Diameter------ ----------------------- '� T ,�,.., Depth _ Liquid Capacity gals. Distance'from-nEaresf well--------__- - ..... istancs from nearest Suilaing-------_----------- - ❑ Distance to nearest lot line--.-_---- ----------------- _ w { y Remodeling and/or repairing (describe):-_--/ 4 --,1 -}1�/Q �, �rj 1Caf.... „�►€_------ . --------••-•------- i ' -.--.---•--------•---•. ..............•-----------------------.------....•--_--•------ i - - --•--• • --- -- ------ ----- •---- - --- • • -----...------•------•---- ----- --•--- --•- ----- I hereby certify that I have prapa'red this application and that the work will be done iti accordance with San Joaquin Caunty3 ordinances, State laws, and rules and `regulations of the San Joaquin Local Health District.! i (Signed) sr¢��----L. o-.--------•----------•----------•--- (Owner an /or Contractor) F BY� '{ {Title}. - __- (Plot plan, showing sire of lot, lac ion of system in relation to wells, buildings,,etc., can be1pleced on reverse side}. FOR DEPARTMENT USE'ONLY ( P APPLICATION ACCEPTED BY----.---- -------- ------------------------------------ ------------------------------------- DATE ... REVIEWEDBY-..----•--••--------- ----••---------•-----._...----------------- •------------r- ---- _- ---�-------------�-----.... DATE---------- •�•-- -�•-----••-----------...-----...-----.. BUILDING PERMIT ISSUED-... = = _L---- - DATE-- I t Alterations and/o r ommend$tions: �- ---- _�'. -- jrG��j #,,” ""�`" f- ....................................... :... ....----------------------------------------------------------- FINAL INSPECTION BY:....... --- =------------------------- Date SAN ,.. JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 WestOakSrroet 124 Sycamore Street 405 Wast 9th Street .. F Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 8-59 9M 8-61 ATLAS '� f