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FOR OFFICE USE: _------------------------------------------------------- APPLICATION FOR SANITATION PERMIT � Permit No. _�K�...._...._..:.. ------------------------------------ -------------------- (Complete in Duplicate) ice. Date Issued � A, _________________________________________________________ This Permit Expires 1 Year From 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. ZY -f s '� , /�e.` LJ.•� / g7, JOB ADDRESS AND LOCATION...: = 1i ---- `'2..� - .... Owner's Nama__�r��t �.L ............ � ...... oi�&C- -T .Address..... -••--- ------ Phone- e4--._ !_ ----------------------------------------- - ------. ------------- Contractor's Name ---- .......e..7A--- _K-----------------------------------........ Phon . •...... -- -•- lastallawill RdsnCe Apartment House CommerciaTrailer IO{ � Number of living units Number o bedrooms . Number of baths Lot size __._ �i__.__��'�._ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. � Character of soil to a depth of 3 feet: ;-Sand E] Gravel E] Sandy Loamlay Loam ❑ Clay ❑ Adobe❑' Hardpan ❑ Previous Application Made: llf yes,date--------------------) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic sewer is available within-200 feet.) Septic Tank: Distance from nearest walk ©--r---Distar a from fo d tion-D- --------Material------ _ a -_ �i quid -� ---=- No. of com artments --------------__+.__SIS tv �:,c d d' th-... ..�-.._ -: Ca aci �o Di spo 1 Field: Distance from nearest�wel Distance from foundation 1. - _ ___: _.Distance to nearest lot Ii Number of lines______ ________ _ _ __ Length of each line----- o................._ Width of trench..__.'_ Type of filter material s Depth of filter material------/_W-----._Total length....._..�Z8jo.!.................. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line................. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------------- Depth------------..................... Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------.__________________________ ❑ Size: Diameter--------------------------------------Depth--------------- ------------------------------------Liquid Capacity---------___-----_-----gals, Privy: Distance from nearest well------------------------------------------------- from nearest building---------------------------------__.___.-. ❑ Distance to nearest lot line----- ----------------------------------------------------------------------------------}-------------•----------•- -------•---------------- Remodeling and/or repairing (describe):_______ _ _____________ ______a_._____<_______ ____________ ------------------•--------------------.._...-----------------------------� ----- ----- ----- ----------....-------•--------..__..------••--- - -- ---------------------------------------------------------------•----------.`-------- ------•---------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------•-•---------------------------- I hereby certify that 1 have prepare this application a4that the work will be done in accordance with San Joaquin County ordinances, State law , d rules and_e 'hi of an Joa u' Health District. ,/ g\ (Signed- Y '�- --- E ¢-.. l�-ems '� -Contiactor) By:________________________'------------------------------------------------------------ __. _...___. __._..._____--------------__-_-- - - ---___7-g ___-; [Title)------------•---_____._.--------__---- (Plot plan, showing size of lot, location of"system in—re-lati o wells, build; , etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY......... -{ + r t. `--------------------•---•----------------------------------- DATE---------- -------- REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------. DATE-----------------------------------------------------....... BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommend'ations:--------------------------------------------------------.............................-----------------•-•------•--•--------•--•--- ----------------.---------- --------•---------•---------------------------------------------------------------------•-------------------------------------------------......---------------------------------------------------------••----•--...._...-. -------------------------------------------------------------------- - ----------•----- a ---- ------------------------------------------------------------------------------------------............ FINAL INSP - - ---------- Date--------- e�y._ .V' SAN JOAQUIN LOCAL HEALTH DISTRICT f 30 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED B-59 RM 5.61 ATLAS