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FOR OFFICE USE: e. ------------- -------------------------------------- ----------I-------------------------- -------------------- APPLICATION FOR SANITATION PERMIT Permit N --------- -----------•----------- ------ (Complete in Duplicate) --------------- ------------------ --- ------------------ This Permit,Expires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Lo I'Aealfh District for a permit to construct and install the%york herein described. in c his application is made ompliantcidth Co- ca - -7549-- 1, e 1�jo_o Ordi"Fance No. _50- OS JOB ADDRESS AND LOCATION'F ---------- .----a!h�... ----------- Owner's Name---------- —--------------- Ta\ll , j ------------------------------------------- ------------------ Phone........... Address- ......................... ........... )F ---- ------------- --------11---------I-------------------....................................................... Contractor's Name--------O.W -------------------------------------------...... ------------1-1--------------- P hone BA 7.73.0-E) Installation will serve: Resiclenr'Pe ?(Apartment House C] Comrnel F] Trailer Court E] Motel El Other E] Number of living ul -;I---- Number of bedrooms -- Numb baths Lot size E] Community system Water Supply: Public system stem Ej Private r 7Depth TO Water Table ft. !;Z I rlo,, Character of roil to a depth of,3 feet: Sand eGravel Ej Sandy Loam Loam F Clay [I Adobe 0 Hardpan ti- 'Previous Application Made: flf,yes,clate.... ---------------) No Rq---New Constru\cfion: Yes Z3-_`No El FHA/VA: Yes [I No R� 'TYPE OF INSTALLATION AND-SPECIFICATIONS: Z (No septic tank or cesspool permitted if public spwer is available within 200 feit.) Septic T fik: Distance from_ijearest well--- ---._Distance fl oun afliol f d JLI---------Material---- ,�J) I,VC?tD I- No. of compartlinel--------:7-—----------- Liquid dep�h---- -- - ----------- .......... . 7 �----------- -----Capacity___..e5_Pq__.. Disposal Field: Distance from nearest ----Distance from foundation....../C.......bistance to nearest lot line-... -,...... Number of lines.---__ --------------------Length of each Width of trench........3611 Type of filier material._A�_O.CK ---------------- -------Depth of filter material----._/-5`__----..Total If 'lengfh----------W-------------------------- -------------- Seepage Pit: Distance to nearest well----------------------Distance-from foundation------------------_Distancl nearest lot line----------------- El Number-of�pif�=-- -_�__ __Lining e�Ial-----�7______S"ize__: -�jal------------------------Ciepf h--------------- ------------ Cesspool: Distance from nearest well:----.:.:_f__,.'Mifance-frorn foundation----------------- . Lining material----------..-----------...--__.-.-- ElSize: Diameter-------------- ------------------------------------------------Liquid Capacity---------_------ - - --,�'- g s. i. Privy: Distance from nearest well----------- alls. I - -----------------------------------Distance from nearest building------------------------------_---------- F1 Distance to nearest lot line-------------------------------------------- Remodeling ine--------- -------------------------r Remodeling and/or repairing-(desc-ribe) ------------11-------------- --------------------••-------------••---•-----------•------------------•-•--- -----------------------------------------------1-1---------------------------------------I------------------------------------------------------------------------------------------------------------------------------ 4 -------------------------------------------------I......--------------------------I----------------I-------------------------------I--------------------------------I------------------I---------------.---------•--------------------------•-- -------- -------------------- --------------------I------------------------------------------------------------------------------------------------------------ I hereby certify that I h and that the work will be done in accordance with San Joaquin Coun ordinances. St e laws .-and an Joaquin Local Health District. (Signed]-.-.. ....... -------------------------(Owner..(Owner and/or Contractor By:-----------------------------------------------------------=- -----•---------------- ---------------------------------------------(Title]- - ...... .............. (Plot plan, showing size of lot, location of system in relation to wells, buildings,_etc., can be7placeqk.eeveirse ifd6); - FOR DEPARTME yT.USE Of4LY-; APPLICATION ACCEPTED - -0 -- ---- -------- ------------- ----------*------------------------------- DATE--..------ ----- - REVIEWED BY--------------- ----------------- ----------- *-----------------*-- ----------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED.............f.-_- --------------------------------------------------------------- DATE ...................... Alterations and/or recommendatiolI .... ---• ----•----•-------------------•----------------------- • ----- ---------------------------------------------------------------------------------------------------------------------------------------------------- ------------- ------------ ------------- ------- ---- --------------__:j----------- -- ---- ------------*-------------------------------------------------------------------------------------*------------- --------------------------------------- -- -------- ------------- ---------------- --------------- ........ �K---------------------------------------------------------------- ------------- ----------------------------- Date.......... ----------- ------ - ------ - - -------------- --------------- ------------------ --------------------------------------------------------- FINAL INSPECTIO ------ ----- 097 -- -- ------------- .......................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 1 124 Sycamore street 20S:west 9th Street Stockton,California Lodi,California Manteca,California Tracy,-California ES 9 REVISE, 13-59 2M 5-62 ATLAS