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___ ----- ----- -------- - -^------�I APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) -------- - This Permit Ell X10ires 1 Year From Date issued / } Date Issued ._��/�/�y` Application is hereby made to the San Joaqui This application is made n Local Health District for a permit to construct and install the work herein described. in compliance with County Ordinance No. 544. ��° JOB ADDRESS AND LOCATION_._ -- --,-f n _ �,,��,, , _-_ �d(, X12 -cam�S Owner's Name_. !L , I r� Address........ �✓ -- ----••----- -------------•-----------------------•------ --- -------•• --- ...................... Contractor's Name------- I -•- - - - ------------------------------------------------ ---------- -•-----•-------•---------I........----•--------- Installation will serve: Residence A artment House Phone................. Commercial ❑ Trailer Court ❑ Motel r Number of living units:1------- Number of bedrooms -------- Number of baths ._...__- Lot size -_-- - Other Water Supply: Public sstem ---•- -----•_- Y ��❑ Community system ❑ Private Depth to Water Table ��f� 1 Character of soil to a depth of 3 feet: Sand ❑ ravel ' $apdy Loam ❑ Clay Loam ❑ Clay❑ Adobe Hardpan Previous Application Made: (If yes,date___.___.._._ �I 1 �o New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: G (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation__-__.._..__ r�,,��,, �d No. of compartments_.__.------•------ --.Material------•------- �� DispasaT t i �� Distance from .N..-Size---•-------•--------------------Liquid depth---------------------•---Capacity . m nearest well tY -•-....... I 1-pa--_Distance from foundation-. C7•___-- Distance to nearest lot line.__ r— y'r� Number of alines.--.----/------- Len Length of each line_------- r g 7� rr ._.Width of trenches Type of filter meferial.r,.1._(_�-----Depth of filter material....... length.___.__.,_ __ Seepage Pit: Distance to lnearest well_____________________Distance from foundation_._______.__ `� ------------------Distance to nearest lot line_________________ ❑ Number of PI ---------------------- material-.--------_- I Size: Diameter_ -••------- --.--.Depth--------------------------------- Distance Distance from nearest weft________________Distance from foundation _ ❑ Size: Diameter-------------------•-------- Lining material •--••--------------- ...._ _ k Depth _____.Liquid Capacity.. - t ,�„_..,.___, _ -.9 _ gals. ----- Y Distance from nearest welt__________________________ ti •� - -' --------- ---- -Distance from nearest builcling-__ ..-` • . r ❑ Distance to nearest lot fine.----_-•_-- I� emodeling and/or repairing (describe):_-._-_ � - . ----•------•--------•-------••------------- -• ----------.--•-- .-----------•-------• .._--- ` ____________________________ ___________ ----------------------- ----__________________________________________________________________________________________________________________________________________________________________________ I hereby certify that I have:,,prepared this application and that the work will be done in accordance with San Joa uin Coun ordinances, State laws, red rules and regulations o +he San Joaquin ocal Health District, q � Ir r -� (Signed)-. ,-' ,� A_X_06;� I _� CA� $y:..- ---------•----.....-•-------------------------------------- ---•----------------- ------------- (Title) Owner and/or Contractor) I ` of-plan, showing-size of'lot,�location 'of sysfem-in relation to wells;-buildings; etc., can be placed`on reverse-side}.• " it FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----'M DATE--- ------------ REVIEWED BY__.-------•--------•------• - ,h - ---------- -------------------------•-- ---------------- BUILDING PERMIT ISSUED.__.------(l_.-_.____-____.____ DATE---____-- - -- ---------- - r .�. Alterations and/or recommendati ons_____________________ __ -- DATE------ ----------------•-------------------•--•--------------•------- --------------- ----------- ;--••--------- •--- ..-•------------------•------------ FINAL INSPECTION BY:----..._.__i FDate------- il SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout I� 300 West Oak street Stockton,California I 124 Sycamore Street C Lodi,California 205 West 9th Street II Manteca,California ES 9 REVISED 8.59 2M 5-61 ATLAS Tracy,California