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FOR OFFICE USE: -------------------------------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .............. ... _ _3° - ------------------------------------------------------- (Complete in Duplicate) Date Issued f = ..� ..----------.-------------------------.._-..--.......... This Permit Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the war erei detcribed. This application is made in compliance with County Ordinance No. 549. ', Gdrr------ - f- ---- �. -�-k_�_ Vin_ JOB ADDRESS AND LOCATION--------------------------- ---• -•- x-- -•--•-•- .... �4 !�.....'a Owner's Name-----------------�Q�M- e9__ -`---�-�bar_yx-------------------------------------------------------------------- Phon Address—.............. -- ---------- - '.. :. ------ %=---------------------- - Contractor's Name---------------------- ---------------------------- ------------------------------------------------------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trai Court ❑ Motel ❑ Other ❑ Number of living units: _/.... Number of bedrooms S. Number of baths IAQ Lot size ......-----E' .._0..... C'e. ......_ Water 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 ORr'Clay ❑ Adobe❑ Hardpan 13-' Previous Application Made: (If yes,date....................l No ❑ New Construction: Yes ❑ No 20"'FHA/VA: Yes ❑ No ❑ .� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted.if pukllic sewer is available within 204 feet.) Septic Tank: Distance from nearest well *1').Distan of rim foyndar�tjpn f !?111....Mater�ai.....-...... Id-- `.... _ No. of compartments-.-----. r �-Size- -- __ 1p(_Liquid depth-------� '-------------Capacity--1 g� Disposal Field: Distance from nearest ell._5I0IlHA Distance from foundationJ40_jkL✓j!_.Distance to nearest lot line-- Number of lines---------— ----------_--..``....Length of each line---- ----Width of trench.--"2 7-. Type of filter material C k1VO f�_Depth of filter material-------f .-.__`_Total length--------------------�2_ --------- Seepage _ .._...-- p g- Distance to•nearest e11- A �/6- H.. ��:-,,A n r .�Y�QaDistance�#rem fou da#ion_s• _. �a 9• tanc to�nearest=iot�iine__. - ee a e It ----Number of Its= Linin material P� =- J g. cal`�,,-m_ � ��Cesspool: Distance from nearest well-----------------Distance foundation--------------------Lining material-....-------__-------....._-----_---_ ❑ Size: Diameter------•-•-----------------------------Depth----------------------------------------------------Liquid Capacity. --............---------...gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building..-_.-.-.--.---..-_-.........._........... ❑ Distance to nearest lot line-_-.-----------------------------------------------.. --_ Cr � modeling and/or repairing (describe): - - ----- - ----- - ;�' f -•-•-• --- --- ------ •--------•...-•-� ----- ------ --- -- --- - {� •------------- -- - ------ —�, !fit' ---- - - f�r---------. . ........... ��frt�C---- r ............................................ ---------------------•-----...._..._..------- -- ..__------...._ _....-----•--...._----..-------.._...--------.. . I hereby certify that l have prepared this application and th t the work will be done in accordance with San Joaquin County, ordinances, State 11a.1 rules and re tion the San Joa uin Local Health District. (Signed).......x-- --- ----- --------------------------------------------------•--•-------------------(Owner and/or Contractor] By:-----------------------------------------------------------------------------------------------------------------------------------(Title)-----------------------------------I------- (Plot plan, showing size of lot, location of system in relation-to-wells,-buildings, etc:, can be placed -on-reverse side). FOR DEPARTMENT USE O Y / APPLICATION ACCEPTED BY-------------------- ---- ------------- ----------- ------------ lG. DATE -�� (� - REVIEWEDBY------------------------------------------------------------------------------------------- -- ------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE.-----------`-------•--...---------------------------------- Alterations ppd/or recommendations:-- ............. --•------ . - % 3 _. -t- - 4 ...-c?-- r . -------------------- ---- _- ---------- IYIt- *,- -- ------------- � -- --=-- - ------ FINALINSPECTION BY------ - -- ---- - --------- --------------------------------------- Date------------------------------------------- ------ ------------................ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 Watt Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS .� -