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llUl ljSl I .. - I . F -------------I-------- ---------------------------------- I ------------------- ---------- ------ ----- --- ------ APPLICATION FOR SANITATION PERMIT Permit No. 1 ---------- ------------- -------------------------- (Complete in Duplicatel ------------- --------------------------- ----------- This Permit Exfres1 Year From Date Issued Date Issued :�el /V/ Application is hereby made the San Joaquin Local Health District for a permit to construct and inall the work herein described. This application is made in c6mplianc A County Ordinance No. 549. 2- D 0-7 0- V, 5ATON_7+JOB ADDRESS AND LOC -------- 4440-,, --------------- .............. --------------------------- Owner's Name -------- ----------- ---- -------------- - -------------------------I----------------- Pholl----------------_-------- Addil Contractor's Name----- ---._.----•------•-•----------- ------------------- --------------------- ........ ------ ---------------------------------------------------- P�hone ...................... r,- II Installafion will serve- Residence A wpartment House Ej Commercial El Trailer Court E] Motel E] Other Number of living units, ---- Number of bedrooms of baths Lot size ..... .11 �;k................. Water Supply: Public system D Community system 0 PrivateX Depth To Water Table Character of soil to a depth 6 1� 3 feet: Sand 0 Gravel E] Sandy Loam [-] Clay Loam [] Clay E-] Adobe Hardpan ❑ Previous Application Made. ji I f yes,date--------------------) No--New Construction: YesK No 0 FHA/VA: KYes 0 No4 I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) rom nee - 0 Septic Tank: Distance f nearest well___6-11 ----Distance from foundation-_-1.0...... ------ *...;�.�-----Capacity../ No, of cotlipartments-.-IIII-" Size Liquid depth li • Disposal Field: Distance fil nearest webl_-:..!,�,-t;$��Disf-a-n"c'e-from foundation....Z:;�--------Distance to nearest lot line-._ Number 01ler Jines------lo.000'_ Length of each line.--?D--- ---.Width of french. -------------- Type of fil matel ri-od -Depth of filter material---- ----------Total length.......... -----------........ Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------_Distance to nearest lot bine__....__.__._..._ El Number of'pits----------------------Lining material-----------------------Size: Diameter------------------------Depth---------------• ----------------- Cesspool: Distance fll�olm nearest well-----------------Distance from foundation--------------------Lining material...____________-_-__.____--_-____. El Size: Diameter--------------------------------- ----D;pth----------------------------------------------------Liquid Capacity--------------------- gals � .11, -�- - --- - - ... _. '' —---.- � � - -E� �� .- � - - - - - �-- Pl Distance from nearest well------ ---- -------------Distance from nearest buildin --------------------------------- El Distance 41 nearest lot line----------:•-•__-- Remodeling and/or repairing il!descl------------------------------------------------------------------------------------------- ------------------------------------ -----------------I-------------------- --------------------------------------------- ----------- ------------------------------------------------------ -------------------------- -------------------------------------- -------------III: ---------------------------------- i-I........----------- ----------------------------------------------I——--------------------------------------------------------------------------------------- ------------------------------------ --------------------------------------------------------------------------------------------------- III ------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I Jill: i COP, ...4�e�_ --- --------------- --------------•--------------------------------------------------------(Owner and/or Contractor) By:--------------------- I-i!---------- ---I----------------------j III (Title) (Plot plan, showing size of lot, Location of system in gelation to wells, buildings, Ill can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BA!----------------------------------- -------- ------------------------- --------------------- DATE REVIEWED BY ------- BUILDING PERMIT ISSUED........1[ -------------------------- DATE----------j.-I------ ------- / ----&- ------------*--------------------- DATE...... Alterations and/or recommen4lkorl---------------- --------------------------------------------------------------------------------------------------------------------------------- ------------ I----•-----..------•-----•------- .........I--------------------- I-11---•------- -------------------- ------------------------------------------------------------------------ -----------------I----------------------------------------------------------------------------------------------------------------- ---------------- ------•----------------------••---------------------- ----- ------------- ----------------------------------------------------------------------------------------------------------------------- ---------------------- -------------------------- -------•------- ---------------------- --4 --- - ------------- --------------- ----------------------------------------------------------------------------------- ------------------ FINAL INSPECTION BY:------I! -------- Date----_----- ---_-------------3-:,--- - 7-4 "3 - - ---------- ---------------- ------------ ----------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS"