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FOR OFFI US - -- ----- ________________ ,l APPLICATION FOR SANITATION PERMIT Permit No. ___......... ... 'I (Complete in Duplicate) a/ & 3 This permit Expires i Year From Date Issued Date Issued ...................... ` Application is hereby made to the San Joaquin Local Health District for a permit fa-construct and install the work herein described. q This application is made in compliance with County Ordinance No. 549. p JOB ADDRESS AN A k N-�I- - ___ �.. I , Owner's'Name__ --- ---- - - ----------- ------- ----- --------- ---------------------------------------- Phone.....................--.......... Address -•--------- -------- -----------------------------------------------------•--•---•-------•--.............................. Contractor's Name........ -- •---------------------------------------------------------------------------- Phone--------.......................... F Installation will serve: Residence `Apartment House ❑ Commercial ❑ Trailer Court [3 Motel ❑ Other ❑ Number of living units: Number of bedrooms __Z. Number of baths Z. Lot size � -�_�................... ...:.. Water Supply: Public system [g?",-Community system 11 Private E] Depth to Water Table.A1tt Character of soil to a depth of 3 feet: Sand ❑ Gravel'❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lerdpan Q Previous Application Made: ,Jlf yes dote_____.___.._____-) No [q--New, Construction: Yes �No ❑ FHA/VA: Yes "No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] / ,p " k Septic Tank: Distance from nearest well___ --______Distance fvor,m founda�tion___/a......_materia�__[..�_��'C fNo, of compert6nts.._,�_................Size> _ _ __Liquid depth_..._ l------------ Disposal ___________Capacity.. ._ ._. F� Dis osal Field: Distance from iieares well :7-----------Distance from foundation.._ !� p _ �.{�______.-.Distance to nearest Int line. ......._.. yi Number tif.linesl_____�_____..__ Length of each line_ , _ ___-.Width of trench__._..... ;i ! � f �`. i .................. I Type of filter materiaLz Depth of filter material__ _______________Total length_._., ' .---------------------- Seepage _______._.Seepage Pit: Distance to nearest well II-__-__' _________Distance fryln fou ation___f�_�_...Distance toneearestl t jli e.y„�f ` Number of pits, ------ ____ ____Lining material_.- _ QGSize: Diameter__.%X �/ Dp 4_ - f i Cesspool: Distance from nearest well_________________Distance from foundation--------------------- material_______----.•__-__---_-_.___•______-_ ❑ Size: Diameter.' ---------------------Depth----------------------------------------------------Liquid Capacity..............•-•-----------gals. Privy: Distance from dearest well__r-------_---------------------------------------Distance from nearest building.__._.-_____________________.._._______._. ❑ Distance to nearest lot line,,---------------------------------- -------------------------------------------••.........-------------------------------------------------- . Remodeling and/or repairing (describe)=------- f= -- ---------------•-•-----_-- ----- -----•-•--- •-•-----------••--------........-•-••- _ } r --------- ; ............... I---- . ......... - Ci d 6o& - ------- -- ---- •-------•- ------------- .:__ -------------------------------------------- ----------------------------`-------------------------------------------------------------------------------- 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 f the San Joaquin Local Health';District. 'I {Si ned 9 )------------------=- - • - -----� -��-�-- -- ----------- --- -------------------------- ----- -------------------•-•• ----•--- or Contractor) By----------=---------------------------------=------------------------ ------- ------~----{Title) l (Plot plan, showing size of lot, location of system in rela ' to welis,'buildings, etc., can be placed on reverse side). ; y; FOR DEPARTMENT USE ONLY I f APPLICATION ACCE,_TED BY------",' LIC - -�rn ------------------------------•--- -••-------------------- DATE------+�. � r6 REVIEWEDBY -=---------"' ---------------------------------------------•-----------•----•--------. DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED: -----------------------------------------------------------..........-- - ------------ DATE.------------------------------------------------------------ Alterations and/or recommendations:---------------- ----------------------------------- -:.... ' 1 `6- ,. -c. '� ----------------- ------------ -- ------------=------------------------•---------••-----•-----l---------------------------. --------- --- -- --•-------•--•-•------ -----------------------------------------•-•-•-••---.................----•...----------..-------------------._..... .. . w ! .. _._ ..G -' ---------------------- Date------- FINAL INSPECTION BY:.._.�//,`. �I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street p 300 West Oak Street 124 Sycamore Street : 205 Weil 9th Street Stockton,California i fedi;California t Manteca,Callfcrnlp Tracy,California ES 9 REVISEb 8-59 2M 8.61 ATLAS II