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FOR OFFICE USE: ' ----------------------- ------------------------------- I _ _..____________________________________________.___. 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 described. This application is made in compliance6`wlth County Ordinance No. 549. JOB ADDRESS AND OCATI fON. '-I 6? 114��[-V......... . .........1�`!IWW' 09------------------------._..._.. Owner's NameQt`4.Ilt_. =f - ------ Phone---------------------------- ... Address-------------10/-------- ---70LE ?------6t. � TW` .. ( G��-1N 1 1P—r.......... .t-t E Contractor's Name----All -NTI_(j q �._..s�F.f>T_7<__: �5R\A_,C F`----------------------------------- Phone................................ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�_____ Number of bedrooms:L=__-..Number.of.baths.l___ Lot.size .... -:_______________________________ � y I j Water Supply: Public system C] Community syAem ❑ PrivateDepth To Water able _ ft. Character of soil to a depth of 3 feet:; Sand ravel ❑ -Sa;dy Loam eClay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-------- ___} No New Construction: Yes N ❑ FHA/VA: Yes ❑ NoFT - TYPE-01= INSTALLATION AND SPECIFICATIONblic - 3� (No septic tank or cesspool permitted if pu "se,Nei issrw:ailable within'200 ftaet:) Septicnk: Distance from nearest well_________________Distance from foundation--------------------Material__-_----___--_..---__--------_--.----.--____--__. 1 J &{ II4'42 - No. of compartments------------------------ -Size------I.. ..I---------••-------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well--f'470__Distance from found bn___._/•______.Distance to nearest lot`l�ine____ 4 -_ �� Number of ies___:-�- f----------------------Length of each li e_____1d_-�7_r_--.Width of trench----..._..7- ----------- Type of filter mate'I`al..." C ,__Depth of filter is 1.___l�-----------Total length.............-�--C.2-------------------- Seepage Pit: Distance to,nearest well......................Distance froTi'foundation-------------------.Distance to nearest lot line______-_-___-___- ❑ Number of Pits------;------:--------Lining material.-.----- --4 .5ize: Diameter----.---•--------------DePth_________.__________....---____-• Cesspool: Disancefr m neare' well----------------- . Distance,from foundation...__---_--_. --.Lining material..__--._________-___.__-.__-____.__. "" Liquid Capacity gals. ❑ Size: Diam er DeP •=-- I----•--------------- 9 P tY Privy: Distance from nearest well_____________________{_-___________I-._. ------Disfa'n'ce from nearest building_____-_-_.____________-____..__-._-----. ❑ Distance to nearest lot line.-----------------�f------------ 9 / repairing (describe):+ ---------------------------------- ---------------------•-•-•-----------------••---------------------------•-----------------------•--- �J Remodelin and/or re ainn ____.____-__ t ----------•-----------------------•---------••-----------.---- I 2 I_ _ I hereby cert' that I have prepared this application and that�he work will be done in accordance with San Joaquin County ordinances, St ws, d rules and r tat' of the San Joaqui Local Health District. (Signed)..... � -• - -------------(Owner.and_/.or. Contractor) ------------------------ '0'--------------------- rifle r (Plot plan, showing size of lot, location"of system in relation to wells, buildings, etc., can be placed on reverse side). t & �__ FOR DEPARTMENTrUSE ONLY APPLICATION ACCEPTED i3Y-------T- 0 -------------------------------------------------------------------------------------------- DATE------- ------ REVIEWED BY------------------------------------------------------------------------ ----------------------------------------------------- DATE--------------------------------------------------' --------- BUILDING PERMIT„ISSUED:-=-= _ =`==------------------------------------------------------------------------ DATE:--------------------------------------------------=--------- Alterations and/or"recommend'ations:_'t_.�—. .- _ •-�---'f< �-- -------��--•--•--• ' ...................................... .: ------•-----•---------------•-•-••-----------•-------•---------------------------------• ------------------------------------------ -------------------------------------------------------------------------------- FINAL INSPECTIO . .---- ------ - Date----------------/ � T�,�rr^_ : SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS