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FOR OFFICE USE: -------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------------- _._.�.....�3-� ------------------------------ -------------------------- (Complete in Duplicate) -------------________---------------_______._.. This Permit Expires 1 Year From Date Issued Date Issued ------r-----�/------ 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. ro)9NT�GF3 JOB ADDRESS AND LOCATION... __.y5__-___-1-4'------ f �.--•----- --ll�..Ctsg_,__QRff_NT---`-t`---Euavt_ ---• Owner's Name---------------!_F.l.F..------• --.�.�_-----••----_-- `T Phone = = Address----------------- `fnn .../r4m.E�------ ------------------------------............-.........................................................•........................... Contractor's Name---1-x.1tIa....... PTf. �� _f -_ -•------------------ ------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial-❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._----- Number of bedrooms umber of baths ./'.--- Lot size'.60 _ .. Q....:9p?14� Water Supply: Public system ElCommunity system Private ❑ Depth to Water Table __! __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date___----------------) No New Construction: Yes ❑ No 2y'FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well...5 ____ Distance from foundation----/Q........Material____B.E.DVV0QX�QO.... /9Din T1 0 N No. of compartments________ _______________Size__ y._ _YX_!�E..Liquid depth-•••--�--- ___________Capacity....__ � _. Disposal Field: Distance from nearest well--->1r_C_----Distance from foundation..__P2........Distance to nearest lot line......_`�••�._..-_-._ J4Dt®TJOt Number of lines......_...... --------------------Length of each line------- ----Width of trench--------- . Type of filter material---�©C—J<_Depth of filter material-----le-_________Total length------------------3.p.••••____-___-_ Seepage Pit: Distance to nearest well----_----------------Distance from foundation....................Distance to nearest lot line.... \� El Number of pits----------•----••-----Lining material--------•--------------Size: Diameter--••---••--••--•--____-.Depth-----•--•-•---.------------------ V Cesspool: Distance from nearest well______-----------Distance from foundation-----_--------------Lining material------------------------------------- Cesspool. Size: Diameter-------------------------------------Depth----------------••-•--------------------•-----------Liquid Capacity---------------------------- gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building__--_____________________._________._..-. ❑ Distance to nearest lot line----- ------------------ -------------------------------------------•--------------------------------------------------._.._....---------- Remodeling and/or repairing (describe):____________________ '1" '.. ----------------•-------------------------------------------------------------------------------------------------------------•--•--.---------------------------------------------.----.----------•--------------•------------ ------------------------------------ ---•-•--------------••----•------•------------------••-•-------_--_-•.--------------------------------•---------------------------•-----------------------•---•------------••-•------------------••------------------- I herebyy ce 'fy t11at I have p +his application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, d rules re u s of the San Joaquin Local Health District. (Signed)-------- - --- ------------------- ---------------------------------------------------------------------------W--------------------------- ------ and/or Contractor) �. By: -(Ti+le� •-•---------------- --- ---- Y• --•--- ----------------------•-------._...--------• - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on t reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY-----_ C -------------- --------------------------------------- DATE-----5`-", �> r--'_----- REVIEWED BY------------------------------ -•+.L . ................. DATE------------------------ .._._... r BUILDING PERMIT ISSUED---------------------:----------- .. DATE.-°.__:----------_.-__ Alterations and/or recommendations: `---=__.:------------------------------ - -----------------------------------------_-------------------------------------------------------------------- ------------------•---.-__----------- ....................-----------------------------------------------------------•-•------------------•--. _---------T__-----_---•--••-i-----------•---__........•----------- --•-•-------- -•---- ------- • •----•-------------- ao ----•-------. --- -- -----)--°--------•-------•--------- -• --._..----•---------------- ----------------------------------------- ...----•--•------•-----...- ---------------••-•-- ----•---------------------------•- •----•----_----•----•-----_ FINAL INSPECTION B _ � Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California yL Ee 9 REVISED B-59 21A B-Sl ATLAS V