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FOR OFF7IC5 E: `:-=-- APPLICATION FOR SANITATION PERMIT Permit Na. - f_7..L.._.. ---------------------------------------- ----- - ,_, (Complete in Duplicate) + Date issued ---•----1_...k?..--- _----------------------------------- ------_-------- This Permit Expires 1 Year From Date Issued Dq ! 2 5D Z�— 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. � + l I • --•----- JOB ADDRESS AND OC/TIONI�r. ..... -f ---7------ ---�--f``'� I )) r� I Owner's Name i7 ! r�GG------------•-,------------------ Phone. Address-•-•--•-•••--•-• ---. = ---------------------•-----------�'----=----------•-----------------------•-------------------------•------•--•------------------------ ' -- ..-. Phone..................••........--•-- Contractor s Name--------------•-• ------------ -••---------•--•------------------------- Installation Installation will seive:�'Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of.living units: /' �Number of bedrooms _ -- Number of baths __-5/ Lot size .. ---------•-•--------------- Water Supply: Public system ®'Community system ❑ Private ❑ Depth to Water Table —47 Water ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made (if yesrdate--------------------I No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t *,Nj septic tank or cesspool permitted-if public sewer is available within 200 feet.) } Distance from nearest well-----------------Distance from foundation_--__-_-----_-__--.Material---------_-----=_............................... 1 , CityN0. fcompartments -o .•-------------- ize--------------------:----------Liquid depth-- ----•--- Ir - ......................" ; - Disposal Fie d: Distance from neare. well Distance from foundation:--, Q_-'_ �istance to nearest lot line....r3..____..__e,(, Number of lines ________ Length of each+line,.- a---Width of #ranch. • '- 1 ( g ,y J� / ---Depth of filter material....___ Total -len th.................... ... Type of filter material d€G- w _ r g a I t Seepage Pit: Distance to nearest well----------------------Distance from foundation__ -------------!.Distance to nearest lot line---------------- ❑ Number of p r Lining material....•------------------Size. Diameter----------------........ epth-------------- ------- ----------- I t r Cesspool: Distance from nearest well-----_,------__Distance from foundation--�_--------__- [ Lining material-----=------------------------------ i O i Size: Diameter------------•------------ - --De th ------ Liquid Capacity----------• ------------gals. Priv Distance from, nearest well---------------------------i Distance from nearest building--_---_----_-__----_---. 1 ❑ Distance to nearest lot line----------------------------------------------- --------------`-......-•-----------------------•-----•--•-••-- I - Remodelingand/or,repairing (describe)-------------------------------------------------------•-------------- ..............................................•••................................. ---- =---------------------- -------------------------------------------------•-•--------•-----------------------........_-............ I ' , ------------------•---------------••--------•----------------------. -_--------------------------••-----••-•-•--------•----•---------------------------••-------•--•-----•-•---------•--------------••-•-•--------•------- i - .r F 1 hereby certify that I have prepred this application and that the work will be done in accordance with San Joaquin County (� ordinances, ta4'e.laws, and rules nd regulations f the San Jo/in Local ealth District. ---. ��! /- - •--•------------- -- - ner and/or Contractor) (Signed) /; l �-� By: """..,.' '" _:. Z s <-- - -------------(Title)--- : /------ (Plot plan, showing size of lot, location of system in relation to s ui Ings, etc.-, can be placed on reverse side). 'F FOR DEPART ME/ USE ONLY 1 r APPLICATION ACCEPTED BY i -------------- DATE 7 4---- � ---------------- -- REVIEWEDBY -•-----------------1.......... ------- ---- -- --- ------•--- ------------• ------- -------------• -- ----•- DATE------• --•-------------- :-----•-•-------- ' '- ` .....- -------- DATE PERMIT ISSUED--:�..-----------------=---------------------• ------=-------------------------- ----- (._ Alterations and/or recommendations:--------`---''-------- --------- ------- q - ..... - - •------- it - �• y - = -----------•-•-•-•-----------------------•------- ------------•--------- •-•--------•---- -------------•--- --- - ----• ................... -.�------------ +.-.... ' ------------ FINAL INSPECTION BY:--'-""'.':"....�- -` :'----------`---------- Date----------------------- f�� ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street + s*c ' 205 West 9th Street Stockton,California i Lodi,California Manteca;Callfornla ' '+ y Tracy,California f ES 9 REVISED 8.59 2M 5-951 ATLAS i