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FOR OFFICE WSE: F_____. ---------- _______________________________._ APPLICATION FOR SANITATION PERMIT Permit No :_. ..... {Complete in Duplicate} 9 / This-Permit Expires 1-Year From Date Issued Date 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. OLl(( — 22J—A/ JOB .�,.... �_ . JOB ADDRESS AND LOCATION _ ^. ./,lids pG .-------------------•---....•--" ..__a . 01 Owner's Name.-.- ---- -- -f---..ids--------- --- --- -----------------------------•------•---•--- Phone --415.4.._ 4--- Addressf••• ..-_ = ------ --.------ A i 1 Contractor's Name-------------------- � r.. �� - -------- . •--•- -------------------------------------------- Phone . �'.3?4 Installation will serve: Residence 20'�_Apartmet House o mercial Tr 'I ourt ❑ Metal ❑ Other:❑ Number of living units'. .___ Number of bedroom �. �. � � � !-_.-_-_ .. __ umber of ba s .. _. of size ... -9 .._._____._ Water Supply: Public system [L�Community system Private [] . Depth to ateraTable,_tfpdtft,,�,,,� Character of soil to a depth of 3 feet: Sand d Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date__.___.___I--------) No C1 New Construction: Yes `glo ❑ FHA/VA: Yes [�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted:if.J ublic sewer is available within 200 feet.} Sceptic T nk: Distance from nearest well.Distance from foundation_ _____.._..Ma elial�- __.___-. No. of compartments s�-----1----------Size_.� -�-�--� ---Liquid depth--- -------_________Capacity.... .. I l . DisV-1 ield: Distance from near wel(�Distance from foundation..3_Q..........Distance to nearest lot line...__.---.- ` Number of lines__ _____ _________ ______ Length of each Iine14!_.�..-��XXVVidth of trench........3�_ _______--_._.____ Type of filter material._. c Depth of filter material____, 6Q_____._Total length____________________Z�--.___-__ Seepage Pit: Distance to nearest well_------------------------Distance,from .foundation------------_-------Distance to nearest lot line................. ❑ Number of pits--------------•I-----Lining material-----------------------Size: Diameter------------- 1......Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter---I-------------I-----•--- ---------Depth----------------------------------------------------Liquid 'Capacity......... -------------gals. Privy: Distance from nearest well ___________________________________------_-----Distance from nearest building____-_-___________-----...__.__..______- ❑ Distance to nearest lot line----------------------- ------- f Remodeling and/or repairing (describe) --------------•--------- --------------------------------••------------------•----------------------------------- #--•-----------•-------•-------------------------------------•:• ----•------•----•- ---------------------------••----•------•------------------------------- ------------------------------•-------.._._.. ----------- -- ------------------------------------------i --- I- i., - 1 -- ------- -- 1`h'ereb certify that I have prepared +his application'and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rule and reg ulet' ns of the San Joaquin Local Health District. (Signed)--- r 4 I ----------- ---------------- ` ---- ner and/or Contractor} V vi �z_ By:-------------------•--....---••---- -.-----------------------[Title}.:.. --- ------------- -------- ----- (Plot pian, showing size of lot, location of system in relati wells, buildings, etc., can be placed on reverse side). i I ( FOR DEPARTMENT USE ONLY I +!;:APPLICATION.ACCEPTED By'----- - ------------------------------- DATE---------- --�4 ----- ----------- "REVIEWED BY '-------- --------------- --- --- --------------------------------------------------------------------- DATE ' BUILDING PERMIT ISSUED--------------------- -_-•---- -------- .'-'DATE.------------------€ ...----------------- -•---- Alterations and/or recommend'ations------------------------------------------------ i= i # } I ! ' --------------------------------------- -----------------------------------------•-----••--------------------------`-------- -----..---------------------------------••-----`-------- ---- r FINAL INSPECTION BY:/F��'°'''L�--------------=----- Date--..--.-------------- ------ -__.-----_--- -------------------------- SAN JOAQUIN-LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Strut 124 Sycamore Stmt 205 West 9th street f Stockton,California Lodi,California ,, \Manteca,California Tracy,California ES 9 REVISED 8-59 VM 5-61 ATLAS