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� FOR OFFICE USE: --------------------------- C APPLICATION FOR SANITATION PERMIT Permit No. .... � I-------------------- ----------- ------------------ (Complete in Duplicate) s�� G Date issued This Permit Expires 1 Year From Date Issued_ Application is hereby made to the San Joaquin Local Health District for a permit to constr install the work herein described. This application is made in compliance with County Ordinance No. 549. 02-7 _ V( 0 3� 7 S4GSo n, f-rl LZE `C nJ . . JOB ADDRESS AND LOCATION -- • - - J - A- ! ------ --- •-------- ' `t _. " .y, �/v Owner's Name----� .----•---•---/tel -- -------------------------------------------------- -------- -------------------•--• ----- --•-- . Phone------------------------------------ Address......... �' v' '-7 --•• �l `.�� -G-------•------------------------------------------------------------------------------ Contractor's Name- .....'z-6'---...+A`........ ------------------------- Phone................................... Installation will serve: Residence Apartment House ❑- Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: ___r!-_ Number of bedrooms _ ___ Number of baths _a2o.__ Lot size --------------------- ....+ v a Water Supply: Public system C1 Community system C1 Private ® Depth To Water Table J-1-12 ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam [3 Clay ❑ Adobe ❑ Hardpan [] Previous Application Made: (If yes,date--------------------) No k] New Construction: Yes I�Fl No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: p (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) .[a ' Septic Tank: Distance from nearest well---!Q'_.___Dista , frro foundation__ a'_-____-_.Mate Material_. 1 _ ` No. of compartments____2"---------- -----Size ...:-Li =:--"Liquid depth---- ---------------.-Capacity_... -_Q"0._. 'W 1 - d __ __________.Distance to nearest lot line____ � _ foundatlon...l_---- � -------- Disposal Field: Number of lines earest well f, Length of each line......t?_0 ..........Width of trench.__ ____________________ Type of filter materi a'Depth of filter material___:__. r'___.__.Total length___ ...._______________________ Seepage Pit: Distance to nearest well__________________ _Distance from foundation....................Distance to nearest lot line................. El Number of pits----------------------Lining material--.--------------------Size: Diameter------------------------Depth_ ----------------------------- Cesspool• Distance from nearest well.-------_--------Distance from foundation___----------------.Lining material---------------------.-...._.__._____ Size: Diameter____----------------------------------De th__--.'_--:" ---------------------------------Liuid Capacity -----------------------gals. Privy: Distance from nearest well _____--_____._____._Distance from nearest building_________________________________________ ❑ Distance to nearest lot line--------------------------------- I Remodeling and/or repairing (describe):______________________ i I -fes f ---------------------•--- -------------------------------------------------------------------------------------••------------------------------ -------------------•--------------------------------------------...-.....----------------------------- _____ f. I hereby certify that 1 have prepares#,ys application and that the work will be done in accordance with San Joaquin Coun r�di nce State laws, ules and regtUtions of the San Joaquih Local Health District. «0nd/or Contractor.) _ °. .r �K... (Plot plan, sho g size of lot, Iota Ion o_sys ea elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - -----------------•----•------------------------------ DATE___S— :------•---•------------------ REVIEWEDBY------------------------------- ----------- -------------------------•------------ •--•------------------------------------- DATE.----------•----•-•------------------ BUILDINGPERMIT ISSUED------------------------------------------- --------------....--------------------------------------- DATE.--------•--_------•-•------ -------------------------- Alterationsand/or recommendations----------------------- -------------------- --- ---------•------••--------•--------•-----••-----...---------•---------------•------------------------------...- -•-•---•-•--•-•---.....-•-•----•---• ••. -------..------------------------------------------------------------------- �. . -----------------------------•---- - ------ - -------------------------------•--------------------------•- -------•---------------------------------------------- --------------------•-------------------------.-..------ FINAL INSPECTION BY:. -- --- ----- -------- • Date,/ Gs 3------------- --------- --------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 2M 5-62 ATLAS - a