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rOR OFFICE USE: "` 5' <----------------------------- APPLICATION FOR SANITATION PERMIT . Permit No. .. .._.__--_-------------_•_-__--_--.--------..---.--------. ------------------------------------------------------ (Complete in Duplicate) Z__• -_ ._____________________________________________________ 1 This Permit Expires 1 Year From Date Issued Date Issued .__... .,ll. ._ ,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. JOB ADDRESS AND LOCATION___._ Owner's Name ,�r� G?!17. fi ----•• --------------------------------------- -------------------- Phoneasa .... Address--------------------------. ----------------••---------------------------------------------------•-•--•------•------•-------------------------•-- -----=--------------........ Contractor's Name--------------- ......................... Phon ��Q -- 1 Installation will serve: Residence B' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .____ Number of bedrooms _ . Number of baths __.tf___ LotvZ .a----------------------=-- 71, Water Supply: Public system ❑ Community system ❑ Private ffo'Depth to Water Table 4-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam ®' Clay Loam [3 Clay El Adobe❑ Hardpon ❑ E] — ._z1. . _ 4. N Previous Application Made: (if yes,date_._ _.____.__. _}�No_�'a New Construction.: Yes_[],=No FHA -� A Yes.❑m;No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: d (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________ Distance from foundation-_._-____________._.Material_______________.___---_------_----_-------------. ❑ tFX/S71/V4§No. of compartments------------------------(Size---------------------- -----.---Liquid depth---------------------------capacity----------------------- Disposal --------- ---------------Capacity-•--•-••--------.----- Disposal Field:; Distance from nearest well-/Lt?OZ_#,.Distance from foundation.-aS1-0_.......Distance to nearest lot line../X?....... 7(15"luc Number of lines---I-----1----------------- G>' _ � ❑ --___Length of each line____� ____________ Width of trench________/ _ . .'................. D Type of filter material..... t.' ____Depth of filter material_____f,�'_"__-__Total length.........Cf7Q__'__________ _______ Seepage Pit: Distance to nearest well-_--_---_-_..._____Distance from foundation_...-_-_-__--.--___Distance to nearest lot line_________________ ❑ Number of pits....11..............Lining -material----••----------:------Size: Diameter------------------------Depth----------------------------- ti� Cesspool: Distance from nearest wail_________________Distance from foundation..-.___.-__________.Lining material_-__.___-..-________.._...._......... ❑ Size: Diameter--_ -----•----------------------Depth------ -- --------------------------------Liquid Capacity----•-----------------------gals.14 Privy: Distance from nearest well_________________________________________________Distance from nearest building_______________---_--------__-.---_-___._. ❑ Distance to nearest lot line-- T""""..-- '"'------------------------------------•-----------•-__------..........-------------••-----------•---••-- I Remodeling and/or repairing (describe):___. WO/------7`C___-____.X.lsf.T/_J✓ ---------t:Pk_,—VAl,__..._•.............................................. I t ---------------------------------------------------------------•-------------------------------•-----------•---•--------------------------------------------------------•-----------------...-..----• ------ 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 regulations of the San Joaquin Local Health District. Si ned .V-A -��i�->��. - Efolw� 1-ye.�-=-__==— or = rtle)._B �/� .. ---------------------------------------------------------{ i. -------�*�- -----------_..._..------------------- (Plot plan, showing size cf lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t � ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �T1_�� ------------------- DATE....... --------------.- REVIEWEDBY--------------------------------------- -------------------------------- ------------------1.......................... DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------•---------•----•---ll------------------------- DATE.---------------•------------------ ------------------------- Aherationsand/or recommendations:----------------- ----------------------------------------I..--------.----------------------••---•-•--••------------•----------------------•------------•--- ..-•------------------------------------------------------------------------------------------------------------------------•............------------------------------------------------------------------------ ------------------------------------------------ ------ -- ---- --- ----•---• •-----------------------------•---------------------------=--------------- ------ -------- --- ----r ----------- ------------•------- FINAL INSPECTI � i � = ? .,. �"".`"` Date------ ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVi9ED 9.59 0M 5-61 ATLAS � r