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FOR OFFICE USE: A. .------------------------- ----- --J°j`�_ APPLICATION FOR SANITATION PERMIT Permit No. ___,1..7..:. . . :_S i a -------------------- ----------------------------------- (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 the work herein described. This application is made in compliance'with Count Ordinanc o. 549. ' i, r . JOB ADDRESS D LOC IONS /_' i rp .------- i J t Owner's Name--- ----•• -- --------- -••------------------- --------------- ---------------------------- Phone_... _ _ T Address----------- -------_----•--- -------- - ------------ ------ ...................................-----•° ; N. Contractor's dame<� W -F= = ` L F• � � Phone.----� dr= / I Installation will serve: Residence Apa ment_House E 3 Commercial ❑ Trailer C21 ❑ Mote! ❑ Other ❑ t � Number of living units: /.._. Number of Ued ooms _�- Nu b r of the ---/ Lot size _--------------------_.__ Water Supply: Public system ❑ Community system ❑ Privateer ' Depth to Water Table _014?ft. Character of soil to a dept of,3 feet:,' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ �` - h Previous Application Made: (if yes,date____________________) No ❑ New Construction: Yes ❑ No^, FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if p lic sewer is available within 200 feet.) S t• , Tank: Distance from nearest well _ --------- ------ Distance, �m f u dation__IQ___.______.Materiai_______ __________ No. of tom artments________________ -...Size _ 1 Li uid de th__..-__ Ca aci Q_.QG� `P ; -�-j 7.r Liquid del? �. w--------- Capacity I� r' Dispos I Field: Distance from nearest weII�Q__.___Distance fFom foundation_ 1� _.Distance 'to nearest lot line--•--- ra Number of lines---•--._�:. ;_--- - Length of each line.....-`"-----�..Width of trench-----Z� Z ___._�____.....-.�r, Type of filter materials. epth of filter mat otal length................. (______:____..__ i Seepa a Pit: Distance to nearest well__[_0Q_______ __Distance from foundation....I.- ••.Dis#ante to nearest lot line____.-__If _.. Number of pits----I________________Lining material' Rc �ounddtion Size:-Diameter_ j 1--___.,Depth__.o '!.._._...._...c a� Cesspool: Distance from nearest well-----------------Distance from ____________...._...Lining material..------------------------------------ 171 _____._..________-__---__•-_--. - 1 Size: Diameter--------------------------------------De Depth--,-. --•-----------------_...Li Liquid. Ca aci ...gals. ❑ P ---------------- q P ty------------------------ g I Privy: Distance from nearest well_____________________ _____S--__________.____._Distance from nearest building................................. ______-- 'a ❑ Distance to nearest lot line-----------------------------I----------------------,-------------------------------------------------------------------------................ Remodeling and/or repairing. (describe): -6-. :... .............................. - 4 - — .. --- .............. ........................................ -... .. d --•-----•----------- ---........- ------------------------------------------------------------------------------------------------------------------------------------------------ ! hereby c Aify.-that 1=have prepares! this-applicat.on and that the work will be done in accordance with San Joaquin County ordin ces,�St a,laws, and rules and regulations oft anFJ inyLes Healt tricf. ] . t � 1_ ��--• ----------. Contractor) '(Signed)' -_ `�_ �� ( -- � _ - � -- w _g • (Title) ------------ (Plot plan, showing size of lot, location of system in r fors to wells; buil trt ;etc; n-be placed•on reverse.side). �Y ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Yax�.`L- DATE ._ .__� - ---------- -- REVIEWED BY...---------•----------•-----_-_- 1 DATE--------•--•-------- -------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------.--•------ DATE.---------------------------------------------------------- Alterations and/or recommenctations:.�.�sc� __ __ _ � �------------ � .d' sv W=--. -.••- ,�- = --------------------------------------------•--.---_----------•-•---- ... FINAL INSPECTION BY:./ ,--. 1..��N ----------------------- Date ® - ----- --5` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street k 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED B-139 2M 5•51 ATLAS