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FOR OFFICE USE: ------------------------------ ------------------------- J - ------------------------ ------------------------------- APPLICATION F4R. SANITATION PERMIT Permit No. _45.. .L..S ------------------------------------- -- --------------- (Complete in Duplicate) Z -._..----------------------------------------------------- This Permit Expires 1 Year From Dale 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. f: � JOB ADDRESS OCATION ! .... _,Q_l.� '� "-`'• •••`•--------•---- • --------------------=------•-- Owner's Name....... ._�..Q. L t . - ----------- ------- ._ ...._. Phone.. .. .- d Address �: lfl?.. -- ----- ` ---- Contractor's Name ..r_` I_ _____ l.,Y.i -/�/. ..�_�xr _..�_ f -- Y. --------- Phon e. ..._. Installation will serve: Residence rtment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: _ __ Number of bedrooms__ Number o aths /--- Lot size .___..!........ .................. ------ Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe Hardpan ❑ Previous Application Made: (If yes,dote____________________) No ❑ New Construction: Yes ❑ No ET FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) ep Distance from nearest well______________ '_Distance from'foundation....................Material------------------------------------------ ...... No. of compartments-------------- ` ize----------------------------.---Liquid depth--------------------------Capacity-------------------- v0s', Distance from nearest weil_ 0. __.._Distance fromfoundation-. _ .__.Distance to nearest lot line___Number of lines___-_.�._. -_-_-____.___ Length of each line L�_�_____________Width of french___s�rj4.��____________Type of filter materia Depth of filter material-__Z __.//----- -4- lengt '� _ ..-_ ::_: , w Seepage Pit: Distance to nearest well__1,0_U_i--___-_.Distance from foundation----- __p_ ......Distance to nearest lot line____...... r Number of pits______ _______________Lining material___�e ------Size: Diameter_.,_j_1/_.___Depth----__. _ '---------- _ �n Cesspool: Distance from nearest well-----------------Distance from oundation--------------------Lining material------------___-_______-_______-_-_._ V ❑ Size: Diameter------------------------ -------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_________________________________________ _______Distance from nearest building-----------------------------------____._. ❑ Distance to nearest lot line---------- ---------------------- -----------------------------------------------------•--------------------------------------------- Remodeling and/or repairing (describe]-------------- __ - _-- ---------------•-------------------•---------------- v1 ------------------...............--------------------------- ------- -------------------------- ----- - --------------------- --------------- --- --- --- ---------- -------- -- - - - --------- --- ------------------------------------------------ ---------- -------------- M�� -- - • - ------------------------------ -- ----------- •-------- --------------------------•----------------------- ---------------------------------------------- --•------- hereby ce i t have re this app!' ati n and at the r be a in c ordance with San Joaquin County ordinances, a aw , es an regula 'ons of a aquin Lo I rrct / {Signed} • ••---••-• .. - ` J Jl(lowroo ontractor[ By-------------------------------------------------•-•-•------- ----------------------- - - [rtlel (Plot plan, showing size of lot, location of system in relation to ells, buildings, et can be placed on reverse side). FOR DEPARTMENT USE ONLY y- APPLICATION ACCEPTED BY------ ----------------------------------Y t DATE------�Cr .....4r! --------- REVIEWEDBY---------- ---- . •••--......--.• ---•- DATE-------_-------------•------.................. BUILDING PERMIT ISSUED--------------------------------------------------------•-•------------------------------•------------ DATE--------•--_ --------------------•------------•------- Alterationsand/or recommendations:----------------------------------------------------------------------------------------------------------------- ..-------------------------------------- ----------------------------------------------------•---••-----------------------------------------------------------------------------------------•-----------------------••--------------...----•----•--....------•----- •----•-------------------------------------------------•--------------------------------------------------------------------------------------............_..............----------------- ................ FINAL INSPECTION BY-1444011-1w-------- -------- Date------/1�7 .14_ 0`-._ . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 340 Wed Oak Street 124 Sycarnore Street 705 Wed 91h Street Stockton,California Lodi,California Manteca,California 7raty,California / E5 9 REVISED 8.59 2M 5-62 ATLAS i'