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/ FOROFFICE USE. r� ------------------------------ -----------.....;------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. _. .... : _. ..._. -,: (Complete in Duplicate) �-�-- ----`�---=--...........-- ------------------ This Permit Ex fires 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. 4 ' ' I; fJ t� JOB ADDRESS AND LOCATION_. �............. � . _.............L� ( Owner's Name--------------------W--�`!n_.. t_.-.. ,Q_:I_�.1I1-•............--------- ' one . Address------------ �1 �' -.h ..c.. --s- =-.....................................................--------------------- Contractor's Name......... -----------•---- ................. Phone .......... x Installation will serve: Residence.% Apartment Hpuse Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 ,`V � Number of living iunits: .__/.,Number of bedrooms_ �__ Number of baths ._�..'_ Lot size'..._....__��.._.�-r f Q . t � - f,Water Supply: Public system V Community system F] Private [jDepth to Water Table l0_ ft. Character of soil to a depth of 3 feet: Sand'❑ Gravel E] Sandy Loam +Clay'Loam ❑ Clay Adobe.❑ Harpen i b rr : A. ' Previous Application Made: (If yes,date-----__ _________l No New ConstructionE : ,Yes No [❑ FHA/VA:�Yes E]' No I "" TYPE`OF`INSTALCATION-�4ND SPirCIFICATIONSi `=— (No septic tank or cesspool permitted if public sewer is available within 200 feet). ., r Se tic Tank: Distance from nearest well _�• .-�IDistance from four da 'on___�l/_- .Material_-_l No. of com artments____.- q P P p � p Size.-•�•---� �-�'--=1,i uId de th_-------�-----------Ca aci ' N,umber of lin ea foun f t'' i s from foundatlo��:".`.:_.__.Distance to nearest lot Iine.___S.._..�r Length Disposal Field: N, 4b r from Weare ell_-- Length of each line-------- .... Width of trench_ -__ -�,jt_. a hype:of filtermaterial: '. PL./CDepth of filter mafierial_` __f_++-.--Total length.--- -----f..........-- Seepage Pit: Distance to nearest well_ �___--.Distance ffom foundation-_-_1�------------------Dist e to nearest lot lin . ,y .,, , ❑ ,.,Number-of pits------- _____________Lining material. ize:tiameter_ ,th� _ '_•_ Cesspool: Distance nDcieamyfreotemr--r-i-e-a-a-ir-el--s�t well e'll___-_-_-_-______„____ Distance from foun dation---._ 'Lining material!_--••-:-.'.............f:.._...._.._l.s_:_--------- ❑ S � � " tLi Liquid Ca aci ' - --.---'-'--7--__ De th__-- _ - = ---------------------- Privy: D%sancefrom 'Vn` nearest well____ ---_-----___----._.�Distere from nearest building___. _ j_ P' "71 y ❑ Ista'nce tolf({nearest .lot line ------------------ Remodeling and/or repalring (descrlliel*_ _ ....L-E-A----l -- ••----------•-•---- �- .. -----•------------------ --•--............................... ----- -------- `` I ---=--------------- -- - ----------------------------- i.:----- ----- -. ----- .... I---------------_---------- - ., r....:..... - --------- ----•------------------------A...._............. -•------------------------------------- ------------ ----------------------.. I here ify't -ha. I have.prepared prepared th' a pli at an hat the work vrill'be done'iri�accordance witK7 an'Joaquin County ordinance , State vrs, and rules andyreg do o e uin Local Health District. 1 t; - ----- --- ---' •--... ----- �------------------------------------------------- (Signed) --� ._. . v aY. ..----�---...•. (Title) : wner an or Contractor) (Plot plan, sho size of lot, location of system_iri relation,irells,�uildings,"etc., can be placed on reverse!side]. t ) FOR DEPARYMtNT'LISE ONLY t REVIEWED BY i= DATE -- r 1J APPLICATION ACCEPTED BY---------- f 1--v_ DATE ------------------------ ,,-BUILDING PERMIT ISSUED--------------• '�• ----------------- _------------- ----------- DATE--- ---•- � L._ � .� - AI'terations and/or recommendations:�.� "'"~�--_:---�^�-�-- ._.__� -.��.T ,-� � ) { --------------- ' ......---•------------ . --• •-- = . r --------0:7199--6 .. -..: #�.T' fkTt.OniS �l .f}cK---------- Oak . ................................... .----- --------------- . 'r ----------------------•---------- '------------- -• ------ ---- --- ---------------------------•-------- ........... ' - ------ -- ----- ------ -- -------•---- ----- ------ = t -------------------------- FINAL --------------•-------- FINAL, IN TION_ -� ^-' --- — -- -- ---------- r y Date_....__ !l- SAN .JO QUIN LOC L HEALTH DISTRICT i 130 South American Street 300 Weft Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 8-6! ATLAS «,ice