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4 FOR OFFICE USE: YL4, � { - . L-r2------------------------------------------- ----------ri --------------------------------------------------------- APPLICATION F(* SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) S L' --------------- ------ . __--w____ _ ---------- This Permit Expires 1 Year From Date Issued Date Issued ..... ......:......... 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 LOCATION.......&L-,2•-- 2AX--1�.�_ = lt,-ewe-y <.. _Q.C?•..,I -.4' --- JOB �p..� f Owners Name. 1 _P0. --....cz .. _Q0?._.....----••-• Phon .1 > ..z Address.......................Z3�' '. --....... ............................ Contractor's Name� .� W� �7 /zr��J c �.2YG'... Phone �� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: �___ Number of bedroom;��[] ber of baths __f._ Lot size ...... -J—" ��. l�Q � -- --- l Water Supply: Public system Q Community system 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____________________) No ❑ New Construction: Yes ❑ No �iA/VA:Yes ❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S is T Distance from nearest well_________________Distance from foundation....................Material................................................. No. of compartments--------------------------Size................................Liquid depth...........................Capacity....................... ;V:led• Distance from nearest welL_Lo _f..Distance from foundatio ._l a--r-...Dlstan¢e to nearest lot line... .....:... Number of lines_______�__-...._..______,_,._.___Length of each line-� `_._.______.Width of trench...:*y , f'�_ -__-.d Type of filter material ?* k. :.__.Depth of filter material-.-.- . _��.-__Total length,____ -------...`__________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. Number of pits______________________Lining material-- i�_..-.Size: Diameter.....��----------,Depth_,/.D----�..__.__ _.... $. Cesspool: Distance from nearest well.................Distance from foundation....................Lining material.......................... .;:.. ❑ Size: Diameter--------•------- -- ---------------Depth--•--------------•------------------ --------------Liquicl Capacity.- ---_---- --••------.gals..' Privy: Distance from nearest well--------------------------------------------------Distance from nearest building.......................................... ❑ Distance to nearest lot line.............................................................................................................................................. Remodeling and/or repairing (describe): 22.. ------------47-11 .............---• -•-----••---------------••-•-•-•••••-•-•------------•-•---------------•-----------------' •-.------------- -------- 1 . :: - ----' ----- -- .---..----' ______________________________ _________________________________________________ ____________ _____ _ _____ -___._-.___---__---_---_-.__-_____.---_ ___._..I hereby certify that I have prepared this application and that the worin accordance with San Joaquin County o ordinances, Sfatejaws, end rules and regulations 9f the San Jo!_quin Loca Health District. ` (Signed) �L�' `tG.1__� l4. __ -E -i� = 1, ' `'; Contractor �� s ) By:................................................................... ------ ,r fat....-�� . --=---------(riitle)---------••- (Plot plan, showing sire of lot, location of system in relet` n to wells, buildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY.................................................................................................. DATE.....................................................---•-- REVIEWEDBY.......................•-----•-----•------------------------------------------------- ----------------•-----•---------------- DATE_-.......................................................... BUILDING PERMIT ISSUED..: ``` - ................. DATE--------------•--•--•--------.-----•--.. ---------- Alterationsend/or recommendation ............................................................................................................................................................. -------------------•---------•---•----•-•----------•---------------------------------------------------•------------•-----•-••--------••--•------•--•-•----------------------••-------•---------------------------------- --- ------------------------•-•--•--------•----------•••-•---••-------------------------....:..-------------=-----•--•----------•-------------------••----•------------------------------•---------------------•--- ------••---•• a ---- .................. FINALINSPECTION BY---------- ----------•------------------ _-_.""�'__-------- Date---------------1----....................................................... 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 Ef 9 REVISED 8.89 EM 6-61 ATLAS