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FOR OFFICE USE: ----------`------ --------------• --------------------- __________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------------------------------------- (Complete in Duplicate) Date issued .... --------------------------- this Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des ribed. This application is made in compliance with County Ordinance No. 549. 2-o7.- .340-01 Cf9c_O C Zai--3-,!f- c_o lE _ �-•�-� � .. JOB ADDRESS AND .LPCATION.. -- Q�CU �-------- rhe[--_--W-01 --- LQ! .-----� --- - -T Owner's Name--------- /-ra--D------.. l Address......, ------- Pliones- f ten --- . y , . v }Contractor's Name---------- c.R--.-- ----- ----. Phone---.......-•---- r_ Installation will serve: Residence g' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ...1... Number of bedrooms Z- Number of baths __�y'Lot size .___.! Cr 8(4.6.. ......:. ::......... Water Supply: Public system ❑ Community system ❑ Private Vepth to Wa er Tab@ee 4- ft. Character of soil to^a depth of 3 feet: Sand ❑ Gravel ❑ Sand l=oam ❑ Clay Loam Clay [j Adobe ❑ and an El Previous Application Made: (If yes,date_____ ____________) No New Construction: Yes �o ❑ FHA/VA: Yes Na septic tank or-cess ool- ermined-if ublic-sewer is-available within 200 feet. Srptic Ta Distance from nearest well ._ ____Dista�F�e�om foundation-__�a.._.-___.M t rial.... _______________ A No. of compartments_.______ _.___.Size !`1..__ .. ..:_..Liquid.de th__._. _. - Capacity ... p ----- .. .. . .. Disposal Field: Distance from nearest well_________________Distance from foundation._................ istance to nearest lot fin` CP(�Tuberif lines-----------------------------------Length of each line-----------------_----------.Width of trench----------------- ------. SAu6 filter material-------------------------Depth of filter material. _.--_. `�-------• Total length---- __._ -----.:�ML �NAcyD W Seepage Pit:t407- Distance to nearest well----------------------Distance from foundation_.... . . .___.Distance to nearest lot line_. ... ❑ -T%Tk f nber of pits----------------------Lining material-----------------------Size: Diameter------.---.--------.-- Depth--------- Cesspool: Distance from nearest well-----------------Distance from foundation______------------Lining material_____________________________________ Size: Diameter______________________ __..De th____---.____________ • ._Liquid Capacity............................gals. Privy: from nearest building------------------------------------------ Priv❑ Distance to nearestlot line l ________________________________________________Distance --•1----------------------•---.---...._._..___.._._.................. ----- I Remodeling and/or repairing (describe):--4 .:-- ------- - -------------------------------------•.......... �►:A �""� "" � ` •---------- ----------•-----------•----------------------------------------- I I - ------•---------•-••-•---•-•----------•------•-•-----•-----•-------------------------------------------•-------------------•---------•---------------------•---... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San aquin Local Health District. (Signed) _________________ ___________________________Owner and/or Contractor BY.........-------------------------------------------------------------------------------------------------------------------------,--(Title]----------------------------•----- (Plot plan, showing size of lot-location of system in relation to wells, buildings,-etc.,.tc n,be placed-on,reverse=side): _ z f FOR DEPARTMENT USE ONLY -� *�• APPLICATION ACCEPTED BY • Q -'--------------------------------------------- REVIEWED BY--------------------------------------------- ------ - ------- DATE------- BUILDINGPERMIT ISSUED.........l--------------------------------------------------....................................... DATE------------------------------------------------------------- Alterations and/or recommendations: -----------------------------------•--.- ---....... ---------------------- ----•------------------------------------ ---•---------••--••-----•-•-•- -----------------------------------••-------•------------------------------------------•--•••--------- ---•---•--------------••---•-----------------------------------------------I----•-- 1 FINAL INSPECT ------ ------ - ---•- ------- Date._..------ ................. - 2 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Capfornla Manteca,California Tracy,California ES 9 REVISED 0•59 RM IS-61 ATLAS