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J FOR OFFICE USE: _ ______ ___ ___ ___ ______ r F r`� r Permit No u APPLICATION FOR SANITATION PERMIT • � " ---- ------------------ -`y . . te iDuplicate} __ (Compleed T.�.�r•aeIssued --tThis Per -mit Ek0irs''Year From'Date'lssu ---0 ---- --- Application is hereby made to the San Joaquin Local Health District for a permit to construct andinstallthe work herein de t ribed. This application is made in compliance with County Ord' ance No.49. r. JOB ADDRESS AND LO ATION_ --_�----••-----•-----•--• - ......•..... Owner's Name ----•--•-- Phone --------- -_2----•-•• -----•--•-- --- -• - - ------------------------ Address.. • AJ.&---- �--- - - -- -- ....... C ... I Phone Contractor's Name ------- # ... ' Installation will serve: Residence �partmentrHouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ tOthe� ❑` '' I --X-- /•e------ ----------- Number of living units: [-- Number of bedrooms --- �_. Number of baths .__ -__. Lot size Water Supply: Public system R_ --community system- ❑+:Private ❑ Depth to Water Table W. ft. j `'' Adobe ardQnrr Character of soil to a depth �of 3 het: 'Sand ❑ Gravel ❑ 'Sandy Loam ❑ Clay Loam ❑ Clay ❑ ❑ No:,,_,/ FHA/VA: Yes ❑ `No ❑ Previous Application Made: fYes,date>-O.� e�- } No ❑ New Construction: Yes ❑ 1� ! TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I, 4'i T k: Distance from nearest well_________________ Distance from foundation _____..._____'.__..Material ..______.______...-.---____•-•---••••.••--••-•-•• � No. of compartments ---------- -------••--- Size -------------------------------- Liquid depth --------- ----------------Capacity ( ` Disposal Field: Distance from nearest well_________________ Distance from foundation .... .....___. ____Distance to nearest lot line ................. ❑ Number of lines.!..-- ` ------ Length of each line ---- -------------------------Width of trench -------_--------•----i..---..---- t T e of filter material____ Depth of filter material_..-__ Total lent _____________________ _______ + I See pag I Distance to nearest weld Distance om __-- foundation_ ,d._._._...Distan a to nearest lot line ter -----------Lining material -4 C -----Size: Diame.Number ofp'ts...4 . ..___.. Cesspool: Distance from nearest well _________________Distance from foundation -------------------- Lining material -------------- .------------ , als. ❑ Size: Diameter -' 'Depth. Liquid Capacity------_---------------=- 9 Privy: Distance from nearest well ------ I-• - ---------•------------------ Distance from near"est,building------------•-----------•-•--•F------•--- 8 x - ---------------- D ----------- -----=---------- ,Y - -----------......................... Z•: --------------------... - Remodeling and/or repairing (describe) y________ _________ _________+ ------------------------------_. .............. k , --. . ......... s / i 1 ------------••--------•-------------------'---... __. -- -� 1 ;y ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rul d regulatio s sof the Sawn Joaquin Local Health District. .1< t --------- Ener and/or Contractor] (Signed) l � . .• n � I BY:--•-------------_- ---------- ------------------------- (Title)_.... -- - (Plot plan, showing size. of lot, location of system in relation to w uild'ngs, etc., can be placed on reverse side}. 1 r I FOR DEPARTMENT US�E1 ONLY i k�A _ DATE------- APPLICATION ACCEPTED BY - ••- r 1 ._._..----f --------------------------•------------- _.. DATE ------------ --- # -------- REVIEWEDBY ----------- --------------- -•------- ----• �--�-�----�-�----.�' t - "DATE.. _._ BUILDING PERMIT ISSUED ------------- ------•---- '.._.__ .._...----- Alterations and/or racommer+dations:_�rf .. '4 �3'_� - '-... � - ----- --- z ti ------------------------------- --•-------------�-------•-------------- ..... ----------------------------------------------- FINAL INSPECTION BY: ----- -.'------------- Date ----i- �-! --- (' -2- --------- ------------------------------------ p a SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street a 300 West Oak Street 124 Sycamore Sheet 205 West 9th Street Stockton, California I Lodi, California Manteca, California Tracy, California ES 9 REVISED 6.69 SIM 9.61 ATLAS