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FOR OFFICE.PSE: -- ----- APPLICA10"N 'FOR SANITATION PERMIT Permit No. ----------- ------------------------------------------ (Complete in Duplicate) Date Issued ---- --------------------------- -------------------- This Permit Expires I 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 if C my Ordinance No. 549. I ? n6jej, Con JOB ADDRESS AND LO ,kATION...... ------ .......... ----------------- ------------------------------------------------------------------------- Owner's Name--------------- -- 72.--...--- ----- --------------------------------------- ----------------- Phone.................................... Address-------------------91/_r...... ---------- --------------------------�;_ ----------------------------------------------*............ ------------ Contractor's Name...-. :7 1 ------- __ ----- ............ Phone.A'SAA.1 ---le. Installation will serve: Residence Apartment House Ej Commercial [] Trailer Court [] Motel ❑ Other I -2 Number of living units: Number of bedrooms .j--- Number of baths _/.... Lot size ...... .. _ _0 40'Ix----------------------------------- Water Supply: Public system C1 Community system 0 PrivatejM Depth to Wafer Table ft. Character of soil to a depth of 3 feet: Sand [j Gravel ❑ Sandy LoaMV _X Clay Loam Clay 0 Adobe 0 Hardpan C1 A Previous Application Made: jif yes,jate-------------------- No 4' New Construction: Yes No El FHANA: Yes [] N TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . - t. I Septic Tank: 4.p. Distance from nearest well___S'___�S. �q!__ --Distance from foundation----- .Material------- ............... No. of compartments------------ �:---------- ----------------Liquid clepfh........1K---------..-Capacity.... .......... Disposal Field: Distance from nearest well.--.,' ...�Distance from foundafion_,___4e=__�....Distance to nearest lot Number of lines--I------_r ---------------- Length of each ...........Width of french,___A�'................ Type of filter material... Depth of filter material_*!��.............Total-length -------------------- Seepage Pit: Distance to nearest well_-- -----------Distance from fojonclation-----4�'-,__zDisfance to nearest lot line___ , - 1, Number of pits__........Z--------Lining material---- -----Size: Diameter-----'11�---- ? - --------- Depth------A-.5 -------. ---- ' Distance from nearest well-----------------Distance from foundation------------------- Lining material____.__._-__-_._____-__________._.--- ❑ Size: Diameter.--_ ---------Depth----------------------------------------------------Liquid Capacity--------------_-----------gals. f Privy: Distance from nearest well---------------------------I----------------------Distance from nearest building____--_--________________---.._---..____.. ❑ Distance uilding---------------------------------------- Distance to nearest lot line-------------- Remodeling ine------------- Remodeling and/or repairing (describe):-----------------------------------t--------------------------------------------------------------------- --------.......:.............••--._._...--_... -------------------------------------------------------------------------------------------------------------------I.........I.......----------------------------------------........%-------------------------------- 4t ---------------------------------------......---------......................................................--------------------------------------------------------------------------------------------------------- ----------------------------------------------------- - -------- -------------------------------- -------------------------------------------- ------------------------------ ---------- I hereby certify that I have prepared this applicafiorian� that the work will be done in accord'&`ncevrith San Joaquin County ordinances, State laws, and rules and regulations of the'San�aquin Local Health District. _T [Signed}-- ---------------------- -------...... e- ------------------------------------------------ -----------------------------------(Ch�tneirind/or Contractor) -------------------------------------------------(Title)................--------------------------- ------------------ (Plat plan,&showa sil a at, cation of�systein relation to Wells, buildings, etc., can be placed on reverse side). tgR DEPARTNT USE ONLY APPLICATION ACCEPTED DATE�_,//�/ - ---- ---- -- ---------------------------- _.es----------------------_---- REVIEWEDBY-------------- -- -•---------•------------- ------------------------- --------------- m-------------------------------- DATE-- BUILDING PERMIT ISSUED........------------•--- ---7------------- - - --------- ----- ------ _4ATfz-— --------_-_------*--------------------- Alterations and/or recommendations:__ --- ---- ............... ---------------- ............................ ----------------------------------------------------------------------------------------------------------------------------------------- ..................................... .............. --------------------I----------------------------------------------------------------------------------------------- .................--------------------------------------------------------------- .................................... ---------------------- --------- ------------------------------------------------------------------------------------------------------I......................................... ----------------------------------__------------------------------- ---------------------------------------------- ---------------------------------- --------------------------------------------- FINAL INSPECTION Date_,-- ---- ----------------------------- SAN JOAQUIN LOCAL-HEALTWDISTRICT 130 South American Street 300 West Oak Sireol. 124.Sycamore Street 205 West 9th Street I Stockton,California Lodi,Califor-nia"i 1�anteca,California Tracy,California REVISED 0.59 2M 5-61 ATLAS 4'.