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FOR OFFICES L ------------ --- - ------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._.. ..__...____... - ----7N__1_ 1�,_ __jlAV - (Complete in Duplicate) Date Issued ..... --- - _----.-__.._________________ This Permit Expires 1 Year From Date Issued Application is hereby made to the Sari Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliancN C�+'u/ty Ordinance No. 549. JOB ADDRESS AND LOC TIgN•••-s-� A- G.._./// 1 I --------------- Phone...------------••----------•--- Owners Name-------- �----- -- -- � ---------- ---- -------------------- -- Address----••---••• `S •-•-- . .. - -- �-------------------------------------------••-------•----•----------------------------------••---•------•- Contractor's Name.---- - �s ---------------------------------------------------- Phone----------------------------------- Installation will serve: Residence-[K,Apartment House ❑ Commercial C] Trailer Court F—] Motel ❑ Other [3Number of living units: ----�__ Number of bedrooms .-7 'umber of baths 1------ Lot size ..•----------------------- Water Supply: Public system {Community system ❑ Private ❑ Depth To Water Table _0_`ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ET' Hardpan ❑ Previous Application Made: (If yes,dt ate--------------------} No ©' New Construction: Yes [B'No ❑ FHA/VA: Yes ❑ No r TYPE OF INSTALLATION AND SPECIFICATIONS:' (No septic tank or cesspool permitted if public sewer is available within 204 feet.) t _ �,, Septic Tank: Distance from nearest w 11_____ ______Distance from foundation__�0____..______.Material__.!"'_ -----•- EK No. compartments---- :: Size _!Y'X.q-------Liquid depth-..--4f----------------Capau+y- Ab. t, / Disposal Field: Distance from nearest well= ~_._._Distance from four dation-Z 1. L�___---_.Distance to nearest lot line.. .............. Length of each line__��----------- .Width of trench._ -------------------------- lql� Number of lines_ ---e .----- ----------- g 9 Type of filter material._ 8 -K---.-.-Depth of filter material___1r___________-Ta+al length---I!�____--------------___________ I e --�! rest lot to nce from ea Seepage Pit: DistNumber of rets rest' well'_ ning.mDateraal L-/�undSize:nD meter___—Mance t--Depth.... lam __._....-- �l ❑ p Cesspool: Distance from nearest -------Distance from foundation.__---------------_Lining material_____._____----______--_______.._-_ 0 Size: Diameter--_,-,..------------------------------Depth--------------------- ----------------- -----------Liquid Capacity- -----•-----------------•--9als. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-____._--_______-.-_.--------------------- ❑ Distance to nearest lot line--------- ----------------------------------- • -------------------------------------------------- -- •----------------•----------------------------•- - - Remodeling and/ r repairing'(describe __ . 1 _ .R...a`t¢/-x ____ - -- - ----- � f - -------••--------------•-----------••----•- - ----- --------------------- ._ .----- 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 regulations of the San Joaquin Local Health District. Si ned - ________________________(Owner and/or Contractor] Title ----•-------•-------------------------- -- ------------- By:--------------------------------------------•_.------------- --- -------- -- -----------------( ) (Plot plan, showing size of lot, location o stem in relation t wells, buildings, etc., can be placed on reverse side). 4 FOR DEPA MENT USE ONLY APPLICATION ACCEPTED BY--.--- .'- ---------- -------•- DATE--/---!7J,7---------------------•-------------- --- - ------- REVIEWEDBY--------------_--------------• DATE------------------------------------------------------------ DATE PERMIT ISSUED DATE-----------------------------------------------------------•- 1 ------.. Alteratio s and/or recom en4ations:-•-----• ---- ---- ---- i -------------------------------- - -- - - --- - - ------------------------- �, ------ ----------------------------- FINAL INSPECTION Date ;,z: SAN JOAQUIN LOCAL HEALTft-DI-STRICT 130 South American Street 300 West Oak Street X124 Sycamore Street 205 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REV15ED S-59 2M 5-62 ATLAS t �