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FOR OFFICE USE: ----------------------------- ------I---- d _.. ----------------------- ------ ------•--- APPLICATION FOR SANITATION PERMIT Permit No. ..,1-_�__..(.sr..... ---------------------------------------------- --------- (Complete in Duplicate)/ ----------------M_ . ..._._ This Permit Expires 1 Year From Date Issued Date Issued ........:.:... � 1 (p - ",m- 3-5- Application SApplication 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_comp'anc with County Ordinance No. 549. / 'r! 01;;, JOB ADDRESS AND LOCATION_0f�,---'-_ _ ---_-= --------LL----- Owner's Name....-----ilt- -- N-..........f 3..U_4K01iS:I-------------- --------- --------- ----------- ----------- Phone_---------------------------------- Address__ k ...................................................... /� / T / Contractor's Name v"--t--4------- --- Phone Installation will serve: Residen? � artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _._ mbar of bedrooms_ ?__. Number of baths t siz Coe .. � ._1-......... -� Water I Supply: Public system Community system ❑ Private ❑ Depth to Water Table .______. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ -Previous Application,Madev(If yes,date_ ---'——;,No=�ew Construction: Yes [n—lgo❑ - FHA/VA:-Yes-❑_No ❑--=_ TYPE OF INSTALLATION AND 'SPECIFICATIONS: - I (No septic tank or cesspool permitted if publli�csjgyter is available within 200 feet.) Septic i5k: Distance from nearest wail_ 09_ /._- stance from foundation__ ' .........Mat ial____ ---_--------".rte No. of compartments-------. _-=.......Size__.. ---_�__�__-=---Li'quid depth----- --------- ----- Capacity...L.:__•----.._._.. 09 Disposal Field: Distance from nearest w III.-=�._Distance from foundation_ ��/_......-.Distance to nearest lot line ...V.. p Number of lines.-_.- -----------Length of each line_fj� 4's®--.Width of trench_____.. Type of filter material.. '- �—� __Depth of filter material.._..��____._-__Total length____________________._ Seepage Pit: Distance to nearest well--------________-----Distance from foundation---.................Distance to nearest lot lin e_......... •- 13 Number of pits----------------------Lining material----------------------.Size: Diameter__...-.--..-.------ Depth____.----------------•----------- Cesspool: Distance from nearest well----------------Distance from foundation-----------------__.Lining material------------------------------------- ElSize: Diameter-------------------- ------------Depth--------------------...-----------------------------Liquid Capacity-----•------•---------------gals. y Privy: Distance from nearest well--------------------_ --------------------------Distance from nearest building-------•.-•-------------•------•_--------. ❑ Distance to nearest lot line---------------------------------------------- --------------------_--............-----------------------•-_-------------------------- Remodeling and/or repairing (describe):-----ret---- `f f� R... i�;._._-f:-�Q .... .t? ... kl.�... .Ste ------------------------------------------------------ --------------------------------------•--•----------- ------------------------------- ..m-. III ---------------------------------------------------- -----------------------------------------------.._...--------------------------••---•----,----------------------�-•--..------------- 1 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,$an Joaquin Local Health District. (Signed) J� t�''' °- i.� -------------------------------------- (Owner;:end/or Contractor) - -- - - �Y�T ------------------•-•-------•--•-----------------------•------- = - - t.{Ti+a - = [Plot plin. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------�----'- 1%4_1 ��------------------------------------------------- =-------- 'DATE -,-- ' �� e - REVIEWEDBY--------•------------------------------------------ -----------------------------------------------------•-•------`= .._ DATE--------------------------------------•------.-...... BUILDINGPERMIT ISSUED----------.-_------A �k----- --------------------- ------•------------------- DATE------------------------------------------------------------- Alterations and/or -;--_-------------- - T`J4- L._1E=1?.---- _. 3- ----------� --.;_a. PTI f --------------------------------------- ............---------- -----------.----------------- ------------...-.--------------------------------------------------------------------------------------- e ....................................M--------------------- - ------------------ -----•---•.. .__ ... - ----------------------------------------- FINAL '. . , . -------•- FINAL INSPECTION Date......7_12__.�. �----------------•-•-----------.. SAN JOAQUIN LOCAL HEALTH DISTRICT ! 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street E Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-89 8M .9.61 ATLAS