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r%.jK vrrit_r Vat- § N- ----------------------------- --------------------------- f 14 -------------- --------- ------------------------ 7 APPLICATION FOR SANITATION PERMIT Permit No. ----------------- --------------------------------------- (Complete in Duplicate) -------� •`=---------- ---------:..... ------------ This Permit Expires I'Yeae From Date Iss6ed 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 County Ordinance o. 549. JOB ADDRESS 6r" LOC TIO ----- ------ --- - -------- --- ----- ... ..... --------- ------ Owner's Name- 44t.11, Phone---------------- . .. ...... --- -- -- -- --------------- -----------.................... Address.--...... .. .........*------------- ------•-----•-----------•-- ........................................ . .... .....................4 Contractor's Name---------------------- I ----------- ........ Phonc .... .. .... ..... ........... ....... ------ ------------------------------------ --------- Installation will serve: Residence [ y'Aparfment�i House C] Commercial E] Trail Motel E] Other Number of living units: .... Number of bedrooms -------- Number of ba .Vj s Lot�,Ze __-M th ---------------------------------- Water Supply: Public Community system [I Private ��Depfh to Walter Table 4-0- ft. upp system 0 Character of sail to a depth of 3 fee+: Sand E] i Gravel F ] Sandy Loam E] Clay Loam [l Clay [] Adobe 9j'Hardpan Previous Application.Made: If yes,date----------------_._) No ®,"New Construction: Yes 0 No Yes ❑ No TYPE OF INSTALLATION AND.-SPECIFICATIONS: o septic +an k or cessj5o_"6l'Oeirifiniffed if public sewer is available'within 200 f4t.) t, Tan 'Distance" fFo��76ar'esf well-----------------Distance from fc'undation---------- ----------Maierial--- ----------------_- No. of compartments--------------------------Size--------_---------------------Liquid depth------------ -------------Ca aci ty...... ................ W1 F41 I riDistance from nea'rosf well-__!-_____.----_Distance'from foundation.....................Distance to nearest lot line................. Number of lines-- •-------•-------------------Length of each line--------------- ------_-----Width of trench Type of filter material----------------- Depth of filter material--------1__._________-Total length______...________--_-____.._.______---.-_- _ r i , Seepage ength------------------------------------------ Seepage Pit: Distance to nearest ell-A404--------.Distance Distance ilpm44ndation../o. D' cp Linin Vo nearest lot line.,:�. ...... --------Depth_ ---------- Number of pits-77 g mate ria W,0P1C-&_--Size: Diamete r__ Cesspool: Distance from nearest ;Yell_____________ Distance from foundation---_---------------Lining material--____-.__-.___--______.._........ 171 Size: Diameter------ ------ -----------------Depth.-------------- ---- - - --------------------Liquid Capacity--_-------------------_-gals. Privy: - ------------ Distance fro�n' nearest well..________.-_-----.._ Distance from nearest building--------------------------------------- ❑ Distance to nearest lot line ------------- Remodeling and/or repairing (describe):___-______-____- J s .......----•--= describe):-----------------............... ....................--------•--------•--•--- ..•-•---...--- -----------------------...............--------------------------------- -------- -_11---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I here ertif that I have prepared this application and that the;vork will be done in accordance with San Joaquin County ordin aws, a0d les and re tions of the San Joaquin Loc Health District. F . . Xtions. .3 1 (Signed) ned): .................. ... .. ... ...... - ---------- . ................. -- -- ---------------4- r and/or Contractor) By:___i....................................... ------ 2 . ...... ---•• ...i. ... Itle)------------- ----/---------------- -- ------------- ---- -- - -------------*.... .. ... 'a U.1...... e'c----c....(Ti (Plot plan,I showing size of lot, locationof system in relation to wells, buil * s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------ ---------------------------- --------------- DATE REVIEWED BY--- --------------------------------------------------------I--------- ---- ---------------- ---- DATE--------------------------------------------------------- BUILDING PERMIT ISSUED --------------------—---------- ------------------------ DATE-------•-- - •-------------••------------••---• A erations and/or recommendations:________.___________________ ----------------_-_----------------------_------------1--------------- -------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------...-•--•---------..._.........-----...----•-. ................................................................. ----____ _ I ---- --------------------------------------------- -------------------------..................................---------- ------ 4f ------ ---------------------------------------- -------------- ------------- -----a_��4t ------------- _41 ......... FINAL INSPEtTION BY:_.._.............. Date---------- ........ ,,,SAN JOAQUIN L0,QAL HEALTH D T r-- 52�, rc_ 130 South American Str of 30OWtsfOak Stroof 11)/a_"_251�5124S, as 205 West 9th Street M.-Mr-st, t Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 2M 5.61 ATLAS