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FOR OFFICE USE: "'. T , APPLICATION FOR SANITATION PERMIT Permit No. ...� (g_ ...................---.................- -------------...... . ....................---..... (Complete in Duplicate) Date Is __.. This Permit Expires 1 Year From Date Issued wed ...;.._. ..ra_7/ Application is hereby made to the San Joaquin Local Health District fore er it to construct and install E ork herein described. This application is made in compliance.brith County Ordinance No. 549. rl �L �,..� f__7_&-V Id/• .r JOB ADDRESS AND LOCATI N-_-_•. ....... .:._. �C.aa �f -•-•• ............ Owner's Name............... ....... _._... '- v`...-/J7?L �' -/ `"'�-- —..._........... Phone.......... _..._.... ... Address_................................ _ --,` ...... ..E. rxr :. ..................._.._...._._ : Phone...........Contractors Name.._............._.........._: .....-------------.. .------------*----------..._... t Installation will serve: Residence G1,4pattment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number Number of bedrooms ._3-. Number of baths .2�Lot size ............ .T.- ` �`�--- --- - Water Supply: Public system ❑ Community system ❑ Private ® Depth To Water Table ..k. ft. Character of soil to a depth of 3 feet:1 Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ f' Previous Application Made: (If yes,date....................) No E� rvew Construction: Yes LJiNc, ❑ FHA/VA: Yes ❑ No Q t TYPE OF INSTALLATION AND SPEtr)FICATIONS: (No septic tank or cesspool permitted if publif` sewer is available within 200 feet.) C�-=- •�� -------- Septic TanDistance from neatest well._....5..#..Distance from foundation....../'.sr_.....Material----- -.... No�of compartments............... ?._, Size...._....�-.t tti.X.�Liquid depA........... .........Capacity.....---._� Disposal Field: l► Distance from nearest well----,f-AL.Distance from foundation_----- ...Distance to nearest lot line....... kN6A6er of lines.... 1.........3.......--_�.-Len th of each line............. e........Width of trench............ f-.--.--. Type of filter mateflial... -Depth of filter material_.__._f. ...Total length........... � Seepage Pit: Distance tto nearestwell....................:iDistance from fo�ndation........._._..___.Dis+ante to nearest lot line-......_...._... ❑ Number ofpits........_....---_-....Lining iaterial.................... Size: Diameter.......................Depth...._.:...................._._. Cesspool: Distance from nearlst well-...............jDistence from foundation....................Lining ma#erial..........._........_.............. ❑ Size: Diameter........ .-1 ------- -----------......bepth.................--- ................' .Liquid Capacity............................gals. s I Privy: Distance from neerett well...................:.............................Distance from nearest building—.............------------------....... ❑ Distance to nearest lot line...... ....-----k--..._...r---------......L........----------._...................._............--......-- ------------- t Remodeling end/or repairing (describe): - ---i" - !-... ......__...... ---------------------------- -........ ....._... -•---....--- - _.............. - .-\ ... - - _._.... ......)(------'-------- -- -- -.!r•••------.-=''�.....................•------------..........-_............................................... ...... I hereby certify that I have prep3red'filis applicationrand that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an i'regulations of the'ShJoaquin Local Health District. (Signed)._.-------•--- ----....-------• •----- � S'# (Owner and/or Contractor) ...................... ......... By:- ................................(Title)................................------......................_. (Plot plan, showing size of lot, lova#ion of system in relation toZvells, buildings, etc., can be placed on reverse side). DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ----- --------r. ?..-----.........................•-. DATE-----......._. ..... ---�r.._T....__..-... REVIEWED BY............----------•--..............-.....---........... --==---:—--•------..........-----._..._......----. DATE....-:.........---••--........--- -- - ----• --••--- ----- ..-�::._ BUILDINGPERMIT ISSUED...................................... .......................................................... DATE---------••--•----•--._..---.....................--------- AMerati/ops and/ racommendations:.-...................._...........---...... _... ............ ......------------.... 7 f i�r7.--.__r.-_...-......• -.n.....5....v�_ --.... ...........f-X.....4/...-------..�-•------..._� �..._..,... -- - ..., f• ..- ...... _...... ------ _ - --- -..... - .......... ................ -•-------........_.......... .............--------....._..... - ............-................-----........... - -- ....-........................................................_................_..--.........------------ ...---•-••-----------......----_...-----•------....................I.. ......--..I............................... ..... ....._..................I........................................------...---_..... ........•----------------------------*--------..- FINAL INSPECTION BY:..............�/.../ . tf . .�`-- :.._ - _ ........_. Date.... . ......Z_/9 .r"..'. -................................... /li SAN JOAQUIN LOCAL HEALTH DISTRICT 190 South American Street 300 West Oak Sireist 114 Sycamore Street 205 Wert 9th Street Stockton,California Lotii,California Manteca,Callf.,Mo Tracy,California ES 9 REVf5ED 6.59 2M 5-62 ATLAS