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1 . . °,OFFICE USE: . ..: Permit No. .. --•---• _. _. APPLICATION` F6 SANITATION PERMIT %______ ------------ (Complete in Duplicate] Date%Issued . _�- ...J14J --- This,Permit Ex ires 1 Year From Date Issued �i---------- ---------- a f ` ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work Herein described. ,pplication is made in compliance with County Ordinance No. 549. ,y. ...---.... •'A ADDRESS AND LOCATION -_ Phone.. _ ___ _____ h ------------------------- ---- o •-- ---------------------- Owners Name--------------- Address �. �z8! - I . .. .. .. ....... Phone---�---•---•--�°�- - Contractor's Name__-__. _ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - Installation-will seryesidence,® Apartment House ❑ - , ................. Number of living units: _t_.___ (dumber of bedrooms ___x Number of bots .�____ Lot size ..... Water Supply: Public system�f Community system ❑ Private ❑ Depth to Water enable:C a. ft. Adobe❑ Hardpan ❑ I Gravel Sandy Loam ❑ Clay Loa [ Y ❑ Character of soil to a depth af.3 feet: Sand ❑ ❑ FHA/VA: Yes ❑ L} No [] Previous Application Made: (If yes;clote--------------------) No [3, New Construction: Yes ❑ Na i Iis TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic,tan!(or cesspool permitted if publiiic sewer is available within 200 feet.] - Septie Ta k: Distance frommearest well----------------- from foundation__.,.___.___.------.Materia_.___...------•----- •-- ic - No. of compartments---- --•----------------- -=----Size_..------•--•-_----•---------Liquid depth-------------- -•--Ca acs i. � Distance +o nearest lot line.___...`. Disposal Field: Distance from nearest well____!#---Distance from foundation •••-- Width of o nes _____________in..r•-r---•---- Len th of each line___________ ___C/-------- J' Number of lines.-=-•--------•--/------- - g Total length--------_------•--�4L............. Type of filter material...- er ---Depth of filter material--- - ............-- pistance from foundstion_... �- -•'Distance to nearest lot line__..__ Seepage Pit: Distance to nearest well------- _A--- � De th__.-------7 l hOt Number of pits__--.______�---------Lining 4matarial.._ s 'Size: Diamet __. .: -- P {� I ** `- ,material------------------------- --------- t V k Cesspool: Distance from nearest well___.-.__.___#._.Distance from foundation. _- _ L a aci __ -__.--gals. Size: Diameter-------------------------:--•--q-`-..De - ---- p ty_________________ __ ro serest building----•----•----------•--•--------•--- Distance from nearest well-------------- -- . k Privy: . •-------------------------•------- • ❑ Distance to.nearest lot line__-_'::'------ ----- - - -------- -----•--- ----•--...--------........ �" - = -- - ..------- ----------------------------------- --- Remodeling and/or repairing (desc ebe):_____ - -•--------------- 4 � -------- ,�- s-, lam° ------------- - , = ----------------------------=------ --------• ----- I her eb 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. ------------------------------------------(Owner and/or Contractor] (Signed] (Tial •-----------•-------•--I----------------------------- [Plot plan, wing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._____-._._._ _ DATE- ------ '--A l� REVIEWEDBY---------................................................ = DATE_... BUILDING PERMIT ISSUED----- ---------•-----------------------------------------•----------••-----....__.._...` DATE ,r ( � - - - ------r ----. - - -•-- Alteratid an /or�eca endations:.- - -. ' --- I �„ _..-- _ .F__ f-�/ �- _= - ---------- _`.N1 --- _ = - - - ,� a!' Y . ,"°------------ ----- 1 _________________________________ _--------- ___...._._...�_;i-.....____ - ............ ______________ . FINAL INSPECTION BY:_..;;_....'..------- •-- - SAN JOAQUIN LOCAL HEALTH DISTRICT ` 124 Sycamore Street 205 Weft 91h street 130 South American Stet ^-:.. 300 West Oak Street Stockton,California Lodi,California manbea,California Traey,California ES 9 REVISED B-99 YM 8-61 ATLAS