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FOR OFFICE SE• APPLKC"ATION F6R SANITATION PERMIT Permit No. ...... ------------------ --------------------------------- -- (Complete Duplicate) ..... /_ / ti--------------------________ ____________________._.._..__ 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. JOB ADDRESS AND LO.CATI Nr .Z -�-7�--------------- � ' ............---••-------- 4. Owner's Name------- ....... _.r�/!�I--------- -----•---•---.-••-• • ---------------•--- ---------- Phone -------------•-- Address---- r''. .....---- ----------------------•-•-------------------------------------------.-------•------------•----•-•-----------•-----------•------------ i S ContractorsName----.......... - ---•-•-----••--------I ------------------------------------------------•------------------------------------------- Phone.........---....--------........... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: ___1___ Number of bedrooms--. Number f baths _1... Lot size . ?- f9h. ________________ Water Supply: Public system❑Community system ❑—rrrifate Depth To Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------I No.IT--lNew Construction: Yes eNo ❑ FHA/VA: Yes nfNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool,permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well_�___r_._:Distance from foundation_`O---•p_--._.Material_ ._ ��- ... ...................... 2-No. of compartments----_ -------------- Size..... _, __Y_� Liquid de th__...�----- ----------Capacity----- --- Disposal Field:- Distance from nearest well-%6----- from foundation_-_ld_---------Distance to nearest lot line................. [ Number of lines________ ________________.____Length of each line......ls�___________._.Width of trench.._.Z. ..__________________ Type of filter rriaterial.74_C_Z�-------.'Depth of filter material./9._-------------Total length------ .......... ... - !o Lining materia __vCA—____-Size: Diameter_-----��_....._.De Dep t See a Pit: Distance to pnearest well_____ _______g Distance om.foundatlon__,l__.�.._.____.Distance to nearest lot line_-........ Number of Its-__...'--- ---�-�--------------- I i Cesspool: Distance from nearest wall--------------_-Distance from foundation------------_-____-.Lining material........--------- ----------- Sze:'Diameter--------------------------------------De Depth ---------•-•-----------------------------_Li Liquid Capacity gals. ❑ i 1 � P q P tY---------------------.----- Privy: Distance'from nearest well--------------------------------____-------------Distance from nearest building------------------------------------------ 0 ________ _________-_•----____.__-__.._.❑ Distance to'nearest lot line-------------------------------------------------------------•-••---------•------------------------------------------------------------------- Remodeling'and/or ----------------------------------Remodeling'and/or repairing,(describe):---' "' ------- ----------_-------------------------------------------- i --• ------------.------------------..:..•'---_... ------- '_-'w'--.....---..»---.....-------•--------....--------_'--....---------•----•---•--------------- -......----••--•-•-• -----------------------------------------------•-------••-•----••=-----•••--------....--`-------------~._.._.................»._..---------._................. f 11 ------------------------------ -- _._•_...------------'-•..--------------------------------------------------------------------------------------- ------------------------------------------------------ - I hereby certify that I have prepared this application nd that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations he an Joa uin Local Health District. : _ y (Signed)------------------------------------------------ -- ------------- -------------=-----------------------------------------------------(Owner and/or Contractor) A ------------------------------------------------- - --- ----- -•-----•--I-------------------------(Title)----------------------- - .� (Plot plan, showing size of lot, location of `syst in rely+i n to weNs, buildings, etc., can be placed an reverse side). ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- _________________ DATE------- -- ------------- ---- ---------- --------------------------------------- -- - --------- REVIEWEDBY ----------------------=----------------------------------------- --------- -•----•• •----•-------..-_....---•---_.... DATE------••---------------------•----•----••----------._:_..-. BUILDING PERMIT ISSUED---------------------------------------------------,-------------------------------- I ------ DATE....................... Alterati s red`'ar recomm ation :_____ .. - --- ------- ------ ------------° - `� -� -- -- -------------------------------------- -------------=---------------------------•----------- ---------------------- ------------------------•-•--.....------ --------------------------------------- ------------------------------------...---------------------------- -------------------------------------------------- �----"" --------------------------------------------- FINAL INSPECTION BY:----13 .. GJ----------------- Date-----f 7--------------- ------------------------- ----•--- 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 ES 9 REVISED 8.59 2M 5-62 ATLAS