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FOR 01`�_7 US ---.---- - 1- .� APPLICATION FOR SANITATION PERMIT Permit No _4 ----------------------------------------------- --- - (Complete in Duplicate) .. ll. i! - Date Issued -------------------------------------- ------------------ This Permit Expires 1 Year From 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. JOB ADDRESS AND LOC/AT.I/ON_.. -------------- --------------------------------------------------------------- ---•-- Owner's Name--------- / _`lam-_... f l'"1� -�------------------------------•------------------------------------------------ Phone.................................... Address------------------t.s, 'p�, -------------------�-------------•--------------------------------------------------------------------------------- ................... •-•-•......... Contractor's Name ,lT �4_0,,0.r;V—--------_---------------------------------------------------------•----- Phone................................... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:''__-?�__ Number of bedrooms _. __ Number of baths .2-._ Lot size%. .� ................................ li ft.Water Supply: Public system 1❑ Community.system Private �epth To Water Table .�D ` ,Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe�-Iardpan ❑ TYPE OF INSTALLATION AN . __ No New Co } @/ nstruc : Yes tion ��o [-I FHA/VA: Yes R--No ❑ Previous Application Made: 11 yes,date............ .... D SPECIFICATIONS: f Septic Tank: Distance from nearest we __.��_�_D r ts'�avallable within 200 feet.) � (No septic tank or cesspool permitted if public sews r,,� l�._.._--.Material_ �j [f�/'<G tJ p istance from fa�undatio ______ __ _________ ______ 02 No. of compartments___ _ __::_`__.___.__.__5ize_s �1 ;, iquid depth.:__ ------ __.-__-_Capacity_/"_9f Disposal Field: Distance from nearest"well ______Distance from foundation-._/-10.'......---Distance to nearest lot line.mo. ....... 031" Number of i lines....... ----------- ---------___ Length of each line... ------Width of trench__ _ / Type of filter material._//,�QDepth of filter material----A�-__--__-__Total length_'_,G �__ --------------------- i /� J l Seepage lPi#:�; Distance to nearest well_-__ � . Distance from fo dation____!St_�_____.D Isn� to nearest lot fine- -------- I nf\ Number of pits____,Z------------Lining material_ pri -Size: Diameter___ _____..Depth__ r ____________________ Cesspool: r. Distance from nearest well-----------------Distance from foundation--------------------Lining Material------.--_-_-___________________-_-_ 13 Size: Qlameter-----------------------------------_-Depth----------------------------------------------------Liquid ,Capacity----------------------------gals. Privy: Distance from nearest well_________________________________._---_-_-___.-Distance from nearest building__________---_.--__--_.-_.____..___._____- Distanceto nearest lot line----- ----------------------------------------------------•---------------- ---....--•-------=-------------•----•--------------------------- g anpaii•i Remodeling d re n(describe): .- /or i g _- - _ - -------- = ------------------------------- -------"-- r 1 hereby certify that I have prepared this application and that the work will be done in acE--- ordance with San Joaquin County ordinances, State laws, and rules and regulations f the San Joaquin Local Health District. ff ✓f/.. _. (Signed)-----.....-•-------------- _'._......----- -- -- ---• - - -- ------ - ------..----=---=:__ .. ---•�--- ...--•• -•-- --.._- ------._._ or Contractor) By----------------------------------------------------•--------------------------- --- -- - -.... ::.:_.._._ (r+le]. .._--- -------- (Plot plan, showing size of lot. location of system in re n to wells, buildings, etc., can be placed on reverse side). _ FOR DEPARTMENT USE ONLY 'ts APPLICATION ACCEPTED BY---- -------- - ------------------------ DATE------ �' -•0------ -- I REVIEWEDBY =----------------- •-----•------------------------------------=--------------------•--•--- DATE.-•-----••--•-------------------------••------••--•-•------- BUILDING PERMIT ISSUED----il.............. � DATE------------------------------------- r------------------- f0 - 1c> ' Ahera#ions and/or recommendations:____ __________Z----_--_.. l. 1lnS-� ...__.__�.s _ s .. CQ� -k_9l1 t C = b,eJtx--—------------ ------------•------------ ----- -------------------- •- -- ----- ---------- . y3 Sp z-------------•L-,fleasV........ ,-.ns-------a'�-------��'�-------�1- eG��? -_.I�c� �.._r�l-,--•--- n/ r _- - -'j-� {'---- i ------� ►_�-----�------t l'�� ri -�.R„�----------- ------- ---------------------_- ......... --------••------•------------------------- FINAL INSPECTION BY:---[2_.,---- ------------------------------- Date---- �_�� --------------------------------------------------- SAN ._ .SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street . 300West Oak Street h: :»� j 24 Sycamore Street 205 West 9th Street -"" �•' , Stockton,''CBlifernia .. to`__ _ •� Lodi,California Manteca,Callfornla� Tracy,California ES 9 REVISED B-59 2M 5.62 ATLAS