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F R OFFICE S /rt -&/_3'___--- APPLICATION FOR SANITATION PERMIT Permit No. .��._1..�..... ------------- (Complete in Duplicate) Z- --------------------------- This Permit Expires 1 Year From Date Issued 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 No. 549. JOB ADDRESS AND LOCATION......... . (� ... . ....... .. � _ rc Owner's Name-------------- ---------- -- Phone Address-------------------•--•-----......----•-•-•---• ...... - -----G- r •-•-------•-••--------------••-------•-------•----------•- Contractor's Name----••------------------ZFF ------- �E � ---------------------....----------------------------------- Phone Installation will serve: Residence 1;3,�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .../_-_ Number of bedrooms 2-_. Number of baths . --_ Lot size -_--.•------------------------------------•--_-_-..-.--_-.-- Water Supply: Public system D--,-C'ommunity system ❑ Private ❑ Depth to Wafter Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ I Previous Application Made: (If yes,date---------------------) No New Construction: Yes ❑ No HA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer�is available within 200 feet.) Septic Tank- , Distance .from nearest well-----------------Distance from foundation--------............Material................................................. No. of compartments----------------=---------Size-------------------------------.Liquid depth---------------- ---------Capacity--• ................. F' Disposal Id: Distance from, nearest well-------�----Distance from foundation-/O._r........Distance to nearest loft line....-...... f Number of line's....... .............:_--_.-.--_.-Len th of each line---- - / �,�i g �.�---•-••----------Width of trench---�. --••--•------•--------- ,G�-"Y•r Type of filter material...y__a4,4�--------Depth of filter material---, `...----_..Total length-----------3j.`..•.......--..__..-- Seepage P' Distance to nearest well----=�-:-----.--Distance from foundation.. 4.--.......Distance to nearest lot line----___-.__.. Number of pits---------/.----------Lining material---races----_-Size: Diameter.-�__ Ie/------Depth---- - ------------------ Cesspool: Distance from nearest well--------------------Distance from foundation--------------------Lining material__.-..-_..•.._-_-------._---.___..... ` ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building---_----_--_-.-..._..----------..--------- Distance to nearest lot line------------ --------------------------------------------- -----------------------------------------I--------------- Remodeling and/or repairing (describe)---------- --- ------- --------------------------------------------- ------------------------- •--•-•----_---_•------------------•__-........---•_----------.-..._---------------y------------------------------------------------------------------------------------------ ----------------------------------------- ------------------------------------------------------------------------------------------------- { -------------------------------------- --.-...--•-•-----------------------------•--------------------------------------------------------------------------------------------------------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 regulations of the Sen Joaquin Local Health District. f' s!/trite--- ------------------------ ---------•-•------- - ...--40wrier and/or Contractor) (Signed)------------------------ = gY= 401�of, f.1 � �.--• ----------------------------(rtlel----------.L4�.-,. lliyt...--- --•------------ (Plot plan, showing size location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------------------------------- DATE s' -------•----------- REVIEWEDBY------------------------------------- ------------------------------------------------------------------------------- DATE-------------------------.------------- --------------- BUILDING PERMIT ISSUED----- -------------------------------------------------------------------------------------------- DATE.-- -------- - Alterations and/or recommendations:- ... 3�']<---fib--- --• -- -- ---�-L-�I� .-�� ------------------------------ ..................I-----------•------••-•------.....--------•---------------------.-...-.--..._..------------------------------------._......--- ----------....._...------•-•....--....................................... -------------------------------------•-•--....--....._:.-----.. ------------------------------------------------------------------------........--------------------------------- ---------------------------------------- -----------------:--------- --------- -----------------------------------•---------------------------------------- --------------------------------•------•----•----- •---------------- ------•-----------......------------- --------- ----3---------......--...------------------ --------------- FINAL INSPECTION BY:-,):!n- ..--. ---r----6.1...............--------------- SANJOAQUIN LOCAL HEALTH DISTRICT 130 South American Street . 30o Wast Oak Street +t,/ 1� X124 Sycamore Street 203 Wast 9th Street Stockton,California �f f Lodi,California Manteca,California Tracy,California >" ES 9 REVISED 8-119 2M 5-61 ATLAS l ' M'