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FOR OFFICE USE: :- --------------- ---- ----------------------------- --. APPLICATION FOR SANITATION PERMIT N� - - i- Permit No. 1_0 ------------- -------------------- ---- -------- --------------- ---- -� ------:` (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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT N __._.....••-- - -,� -----------=- _- - Owner's .Owner's Name ----------- Phone...zya_4'7AZ6 /`. Address --- 1 Contractor's Name__ Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: *4.- Number of bedrooms _i`,___ Number of baths __-J_ Lot size ....,1Z©_ __----- 1-yr..-��______:-_ Water'Supply: ' Public system a Community system ❑ Private El Depth to Water Table ........ ft. Character of soil to a depth'lof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,( Hardpan ❑ M. I Previous Application Made: -(If yes,date-------------- No)M New Construction: Yeses—No n,i,,FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: 1i 1 p No septic tic tank or cesspool permitted if public sewer is available within 200 feet.) ,` Septic Tank: Distance from nearest well___ Distance rom foundation..../_Q---------Materi I_--_--__ 1 .. No. of compartments---------�------------Size------ x�� Liquid d - epth----......9 .-.-------Capacity.....90.0.:..... C Disposal Field: Distance from nearest well Distance from fovndafioneX__....___.Distance to nearest lot line.__.._�4_..... Number of.lines.............. -------- Length of each fine= _ _Sd Width of trench... _ .. _f......-----•• --en - Type of filter material-_. --��i pt}i of filter ma`terial---.:� ' "+ � " = - - Total len th_•-.-- - t ------ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line---------I.... .._ ❑ Number of pits----------------------Lining material-----------------------SizeDiameter-------------------------Depth----------------------------- Cesspool: -----------Cess ool: Distance:.from nearest well----------_------Distance from foundation--------------------Lining material----------,..........._ ❑ Size: Diameter.------------------------------------- ----------Liquid Capacity gals. ----•.--- Privy: Distance°from nearest-well-_-__-------- ---:Distance from-nearest Ejuildin g--------------------------------------------- ❑ Distance'to nearest lot line - = rrn -----••----------------------•----------.-. � l I Remodeling and/or repairing) (describe)=-'--=----------------------••-------- ;--•--•-•--------------•-----------__._----..- -------•------ ...----------------------------------------------•------------------------•----------------------•---------------'z---------------------------------------------------- -- ----------=-------------•-----•----------•--•-••- ---------•-------• a., .. . . -----------•----------------------- ------- --------------------.........................----•---------- i --•------ I herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and regu tions of the San Joaquin Locel,Health Distrkct. _ .�_ . Y (Signed) r �'� �� I ••. ----- --------.... ----------•---- -------------•---------------------••------------(Owner and/or Contractor) C ---- --------------------------:------ --- ---- ----------- --- - --------------------------------------- -- . Ian, showin size of lot location of s s+em in rely - •---_(Title)___________________________________•_.•..----.- ---------------- (Plot - P 9 f , y tion to_w.ells,buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE'ONLY ,err Y APPLICATION ACCEPTED BY_-_ - _____-_-__ _ DATA :' =T REVIEWED BY.. ------------••--------------- DATE-=-• •----- BUILDING PERMIT ISSUED----------------- -------------------•--------------------------------------------•----------------- DATE. Alterations and/or recommend'ati ns:----------- ----------------..._-.- -------------------------•------------------.--------------------------_------------------•_.._. •-------- ------•-------- t ---- ------ --------------- ---------- --• ------------------_---------------------------- --------------------------------------------- -------------------------------------------------------- ............ . --------------- - -------------- --------------- -----------------------------------------------_------------------ P --------- -------------- -- ----------- 6 FINAL INSPECTION BY:--- ' -- •------- Date---------------------------------- - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED g-59 2M 8.61 ATLAS ti �I