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FOROFFICE USE: --------- -----------:----------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --1 (Complete in Duplicate) T/ 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 descrbed.. This application is made in compliance with.County Or inance No. 549. p7 > N `�,� JOB ADDRESS AND LOCATION-" &. .. — s ��1...-- / t Owners Name____-k _ Yi ...,..... _...._ .. ------------9- - ---------------- Phone---........... Address- 1. ---- ••-• . i Contractor's Name__ __ _ .dc-_-�� _-• ----- C -,�.�.. s?--- ----- Phona,�'1r'`j f ----- Installation will serve: Residence artment House Commercial rb' ` P ❑ ❑ T Iler Court ❑ Motel ❑ Other ( L Number of living. nits: _�.�- Number of bedrooms_ Number of baths of size __-_-� � .. . o Water Supply: Public system<0 Community system ❑ Private &15epth To Water Table -------- ft. ;i I Va Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑`". Previous Application Made: (If yes,date---------------------) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lit wer is available within 200 feet.) Septic Tank: Distance from:nearest well QDistance from fpundaion_1-± ....._.____IVlateria€_ No. of compaFtAnts - --------------------Size_57Y---?�- - ---Liquid depth--- ---------------Capacity.-I- 0-a - Disposal Field: Distance fromfnearest wel€-a,.�.o_r_--._Distant hpm foundation " Q r 9 /ga� _______ _____Distance to nearest It lime_ _. ___.,r-�fT;Z Number oflines_ _ ____ ________ ___Lengi oat lin Width of trench---------- ------------3aQ-Type of filter materia � WIj_.Depth of filter material_-_-1_�.r1-_-.-.--Total length-___---_ -- ___i , ` Seepage Pit: Distance to nearest well_______________ _____Distance from foundation to nearest lot line__....------_._-_ ❑ Number of pits---------------------Lining material-----------------------Size: Diameter------_---------------Depth-------------------------..------ Cesspool: Distance from nearest we€f-----------------Distance from foundation--------------------Lining material--.------_-.--_------_-...._.-_----._ ❑ Size: Diameter------------------------------ ------ Depth--------=--- -------------•---------------------..Liquid Capacity------------------•-----•--gals. Privy: Distance from nearest well--------------------------------------------------- from nearest building___-_-----_--------_-_______._...______- 1 ❑ Distance to nearest lot line a Remodeling and/or repairin (d 'be): ---rt------- �/ ..... -� __� T _ [ = '-------------------•---. !tpnl�T S F'-�------SK!.—:t` -------730 ------------------------- ---------------------------------- - ------ --•-----------------------------------------•------------------------------ --------------- 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 oVlhean Joaquin Local Health District. (Signed .{--- -- --- --------------------------------------(�jo Contractor) By:----------------- •-•---•------------------.... ...........(Title)_ )Plot plan, showing size of lot, location of system in relation wells, buildin , e c., can be placed on:reverse side). T FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -----------------------------------7-T. j} -SIL _ DATE..-.------- - k--- --REVIEWED BY---------------•----------------------------- ---------------------------------------------------- - ------- DATE-----------_-----_---- BUILDING PERMIT ISSUED-------------------------------------------------------------- ----------- DATE. Alterations and/or recommendations------------.....---- ---•-••---------------------- ------ --------------------- --------------------Z------------------FF1--27. P/�Pmt ------U.15jFD_.... ---------- ---•--- ----------------------- -------- PTZC .._.1z --------- ------------------------------------ ....... ....... :.... - ----------- --- ---- ----�-rte-'--A = �� t:(T------- - FINAL INSPEC BY -- . !LGJ.- ---- - Date--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak StT-eet `124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California _c: Mont"*,California Tracy,California ES 9 REVISED S-59 2M 5-62 ATLAS f