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FOR OFFICE USE: ._____ y APPLICATION FOR SANITATION PERMIT Permit No. .../-------------------------------------------------------- ..... ------ (Complete in Duplicate) __ - .__ I 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 dinance No. 549. JOB ADDRESS AND LOCAT N--• r �' X-----Ls ."T-.Ci �if+� -------•--------------/--------------�-7-- Owner's Name-----1 : -- -�--•-- --------- �_C�x --------- ------- ----------------- Phone.--- �..- - -- -- - - -- - -- Address • C -•. . -If.0• �!S' f/ 1._ �'Ld,t _ f -----_-------_-------- Contractor's Name..—T— ----------------------------------------------------------s�A? :lll�4� ► x �� ----•-•-••------------------------------------------------ Phone.hty---� � l.-•• Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other* Number of living units:--�-__ Number of bedrooms""=-i'Number of baths -__ ... Lot size __ Q.r.R.i -.-�`t- -0.1•••••-•- i We e{ r`Supply: Public system ❑ Community system ❑ Private Depth to ater Table �. ft. I Character of soil to a-dep{h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay Adobe❑ HardgI ❑ r:.. t ' �Orevious Application'MaJe:.,llf..yes,date-=.___.___..______.f tNo ❑ " New Construction: Yes ❑ No FHA/VA: No❑ No ❑ [ '- �. -�. fYPE,0F4NSTALL4TION AN6 SPECIFICATIONS: ..d..-w - 1 " (No septic tank or cesspool permitted if pub Sewer,is availabie within 200 feet.) .W - Spptic'Tank- .. Distance from-nearest well= ':—'Distancewfrom-fovnda ' -:_ _.ti Kvateriaf.:_._ - ' No. of compartments_____ ....-- '"/�__Size_ _... +.3--- _-Liquid depth___ ...f___.____Gapacity_____. Q..� <- { 9 Di I�;Field.: , Distance from nearest well_iI_S7._____Distance from foundation..--�! .r.__.[ istance to nearest lot line......... �- �,.. , ,• , �;.. Number of lines__ _�a_ ____________ _______Length of each line__t__ _ Width of trench.49,1V -_ Type of filter materia. ...__Depth of filter matef ial____,/ ��____--Total length--------------------t�—-----__--_- ,, r ,r A Seepage Pit: Distance to nearest well----- _'i ---_-_--Distance from foundation....../67.......Dist nce to nearest lot 1'ne.....- i Number of pits..__.---j_.___-_____Lining material._13�'_ j{__.Size: Diameter_"T&�fl'(. :_IC.-....Depth------4 --------•/.�"�� Cesspool: Distance from nearest well_______________Distance from foundation-------------------.Lining material------------------------------------ El Size: Diameter--------------------------------------Depth---------------------_•----------------------------Liquid Capacity-----------------------------gals. i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------..-..____________-_._-_.___........ ❑ Distance to nearest lot line--------------------------------------------- --------------------------- ----•---------------•-----.--------•---------------------{------ R-------odeling and/or repairing {describe):_ ..... ---- -- ------------------------ -- . . .. -................................, --•-••----------- -- ---- - nn ----------- ---------- ------------------........-------- ----- ••d#� �. ------- -----------------------•------- ----••-•-------------------------------....-•------------•----•------•-----------------..._....-...---------------------------- I --------------------------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, Staegaws,,and.rul sand regulations o he San Joaquin Local Health District.— � I L . f -- (Signed) Contractor --- - --- - --- -t n �� ) N By:= ...------------------------------------------------------- (Plot `1 - ---------------(Title)------------------------------------......- ------------------ --------------------------- ----------------- , y (Plot plan, showing size of lot, location of system in relation fells, buildin s, etc., can be placed on reverse side). , FOR DEPAR ENT USE ONLY ' APPLICATION ACCEPTED BY--- -----------•-----------------------•--• DATE-----/ —----- -------- • - REVIEWEDBY---------- ----------- --------------------`--- ------------------------------------------------------------------- DATE----------------...•--•-------------------------...-------- BUILDINGPERMIT ISSUED-------------------------------•-------------------------•------------------------------------------•--• DATE------------------------------------------------------------ Alterations and/or recommendations:___` �l/Q_.___ Nl.-Ste_.....ZL4------p1-FElar- � ?. 1 lcr ... -�-I�.._.....iA1_� nl .T .,-------------J/ -5'tt40 -EF.R------ ----------- -------------,. . . ---- -----I------------------------ -------------------------------------------------------------------------------------- -- -- --- ---------- ----------------------------------- A ......V--------- / ------------------------- FINAL INSPECTION—Ba' — . -------- - --- - Date-------I/._---1..". �- --------••------------•--••--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED B-99 ZM 5-61 ATLAS