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VUK .C �UFt "E USE: rr �. .............. 3.. ------.......... .___. . - APPLICATION FOR SANITATION PERMIT Permit No. .--- ---•------------------------------------------ (Complete in Duplicate) t ------ - - ---- This Permit•Ex ires 1 Year Frorn Date'Issued Date Issued `j 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. I r JOB ADDRESS AND LOCATION._.... - ----------------- ,,Z, !� l Owners Name -- ----- --------•---•-----•--- Phon%/Q__--ngjja.1,�_ k. Address "f g ( d. � ----------- "--------------------------------------------- -------•---•---------- 34 Contractor's Name..... •---------- --•----••••---•---•---•--------•------------•-•----••--------------------•--------------- .............. Phone................................... Installation will serve: Residence [-]I Apartment House ❑ Commercial K Trailer Court ❑ Motel ❑ Other ❑ w.� Number of living units: _ Number of bedrooms .-_ Number of baths . '. Lot size .'g3_ _ _/$_ .__�L• ..X.1:36._.__._i Water Supply: Public,system"K^Comrrsunity'system_❑ -Private [_1"-Depth-to-Water"Table ________ ft. Character of soil to a depth-of 3 fee`:. Sand E] Gravel ❑ Sandy Loam [3 Clay Loam E] Clay ❑ Adobe' Hardpan ❑ Previous Application Mado llf yes,date____________________) No)' New Construction: Yes ❑ ' No 0'';FHANA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`or cesspool permitted if public sewer is available within 200 feet.) Septic,Tank: Distance from nearest well It 1,4.�..Distance from foundation----la---------, aterial_% No of compartm�nts---------a,_-___------Size-- - -.7(_q---------------LiquidCapacity----.$'LIQ_--- Disposal Field: Distance from nearest well �s.<..,Distance from foundat�nr__1 __..�...Distance to nearest lot line. _ Number of�lmes___j ^_-_____.____Lenpgth of each Iine�Q II Q 9d`3DWidth of trench____ _- _. ----•-- T +e of materi Depth of filter material..._ .p__________Total length___....baa...................... vp al-��e to P r g ., Seepage Pit: Distance of nts rest welt------=-------------- L�nin material.______._._____,__ _.Size: Diameter__--Distance to nearest lot line.................___-.Distance from foundation.................... 1 -------------------Depth-----------------------------••-- Cesspool: Distance from nearest well___________ Distance from foundation________:__-__--'__:Lining material,-------___________._______._____._._ ❑ Size: Diameter-"--- ------------------ ------------Depth-----------------------------------------------------Liquid Capacity----••-----•--............gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest•building.--__-_-_______________________---.----.-. ❑ Distance to neares0ot-line------_------------------------------------- -----•---------------_-------- f Remodeling and/or repa`irig (describe]:-_ erre_ ___ - _ ,. �L-•,• `' �' __--ka..�_, - ^7rc4� -- -------------------- -----------------------------------------------------------•-•------- t , I , -----------------•-•-•-----------------:-----------------------------------•- -- ----------------------------------•------------------------------------------------••--•--•-----------------------• ----•---------------- 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-a- regulations bf,the San Joaquin Local Health District. - ` - - i•� ------ •----- ---------------------------- -----Signed).- ___. —.: � .__-(Owner and/or Contractor) By:--•---------- - - --- --` ----- = ...............------------------------------- (Title) (Plot plan, showing size of lot, location of system in relation,to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY, y n APPLICATION ACCEPTED BY------ ----------- _R -- ---- DATE_! :_ct�. -.r _c�.__-_(,P- ,--------------- `------ REVIEWEDBY •--- •---- --------------- --------••---------------- -`-----------------=----•--•-------•- DATE--------------..---_-_-- ' BUILDING PERMIT ISSUED--------------- �------------------.........--------------------------------- ........ --- DATE------ ------------------------------• -------- Alterations and/or recommendations:�Q_-. _-.�.z _�_ s - . _ ,-. 5t7 +�.-_ _ "-_ �0---- - :... ................... ;ob~...... ----- --- --- --- --------- --- • --- -------------- ------- -- ..._ -----------------�---- ----�-- --`-- --- - ------_.__---------- Z_ •.• FINAL INSPECTION BY---- -------- ---- 4.(/.----- -------- Date----J� --- t SAN JOA IN LO L HEALTH DISTRIC 130 South American Street 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantua,California Tracy,California ES 9 AEVIH6o 8-59 2M 5-61 ATLAS _ I