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FOR OFFICE USE: ----------------------- ------------ -------------------- --------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. T.k? .__-_ --------------------------------------------------------- (Complete in Duplicate) ----------------------------------------- -_----- - __- 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 t e wo herei+riescribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO .ATION__ � .-..€, ` c ----/�'1/---- --- �__l=_A-THO -----8�------------------`-� . y Al Owner's Name... �� _• '..:.... Phone •--- ---- ---------- ------- ----------------------------------------------- ---- --- `------------------ 1�-j-/V-----/5717`----•-...........A4A_r\l-Tr=-�. .-�............----------------------------------------------------- Address--------•- .�� ...-� � ------ Contractor's Name-A1AN -F-K= -----51F-j.M«-._5,Ep-V-1'-c —-------- - ---------------------------- Phone...............-............=...... Installation will serve: Residence [-] -Apartment House [-] Commercial Trailer Court ❑ Motel ❑ Other 01 Number of living units: _ Numer� bedrooms _ jNumber of�hs -------- Lot size .... Water Supply: Public system ❑ Community syst m ❑ Private Depth To Water Table __. ft. Character of soil to a depth of 3 feet: $andGrevel ❑ Sandy Loam CIay.Loam ❑ lay ❑ Adobe❑ Hardpan ❑\ Previous Application Made: (if yes,date----------- --------) No �New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATIONAND SPECIFICATIONS:__ "R(No sepiFic-tank or_cesspool permitted if public sewer is available within 200 feet.) F Septic ank: Distance from nearest well--- ---__Distance from foundation--------------------Material_---_--..---.--_--�-------_.--`---..----- [ No. of compartments..---..�-- .-.---Size....3X'7 ._liquid depth-_._----�--.--------.Capacity... --_-_ Disposal Field: Distance from nearest well.- 0.-.-Distance from foundation....IC---------Distance to nearest lot line---_`_---__-_x / / Number of lines--------/------------------_-_-_Length of each line------- ----------Width of trench------- _._................ Type of filter material...,-P -.__-Depth of filter material._-. -------Total length.-.......--�?�J--_--_______________ 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 wrdl -------------Distance from foundation-------------------.Lining material------.-----_-----.-.__-----_.-.--.__ ❑ Size: Diameter---------------------- --------i ,-----Depth----------------------- — '- --- � •iquid Capacity---------------------------------------------------gals, r Privy: Distance from nearest will.-----------------------------------------------Distance from nearest building--------------------_----___-- .-.-.. ❑ Distance to nearest lot line------------------------------------------------------ -----------------------------------------•---•---------------------------------------- Remodeling and/or repairing (describe):------------------------------------------ ^-------------------------.... r =----------•---•-•------• ......................I--------------- ---------------------------------------------------------- I h ed will ordinancZ,L.te taws,aril u e on� gulations application the San Joaquin LocalkHeal hedone ic+n accordance with S Joaquin ------ -- ----- -- ----- -----•-------- •- -------------------------------.._.---- -- f at I have County (Signed)•. C GC------- - ..... . G yt--��- '�- ---•------------------(Owner and/or Contractor) �y= - == ----_----- ------------ ----------=------------------------------ _(Ti+le)=:-:_= - _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r/ y - T- 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--''-• -------------------------•-------•-•-•--------- --------.... DATE----------�'- -:- } '" ^ REVIEWEDBY------------------------------ ----------- --------------------------------------------------------------------------- DATE-------------------------------------------- --------------- BUILDINGPERMIT ISSUED---------------------------------------•--•-------------------—----------------- ------------------- DATE--------•-•-------------------------------------------------- Alterations and/or recommendations:----------------------------------------------------....-.._--------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- ---------- ----- --- --------- ----------------------------------------•-.-.....-------------------------------------------------------------- ---------------------------------------------------- - ------- r -- ------- - ---- - ----- ---- ------------ --i-- •--•--•-••----------••----•---------------- -- -• - --- -- ------ ------------- ------ ------------- ---------------------------------------------------- FINAL - --..._F1NAL INSPECTIO Y:., 7 Date ? T�ft' ----------- 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 Traeyr California ES 9riSEb 8-59 i.2M 5-62 ATLAS I -