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FOR ICE SE: �=_ APPLICATION FOR SANITATION PERMIT Permit No. ----- - ---- --------- - ------ ------- (Complete in Duplicate) , ,� r t Date Issue --------- -------------------- 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 with-County Ordinance-No. 549. JOB ADDRESS AND LOCATION.... '*✓? �___ ___0- ►�-._ -................. '�-' q ..-------- Owner's Name-----MU-A-) --• ----- . .- f j 'S-c __ Phone.......... ---n-----�-- �- -- Address.----....--•- 6 ------ -- <------------------------------------------- Contractor's Name ..---•----.7......-' . ....... ---- -- r`- �- � _ = Contractor's Name------._- -h.r�_...:! r �� `" - .., •ce a ------ Phone--•-----------------------•-------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [Motel ❑ Other ❑ Number of living units: 6___ Number of bedrooms -------- Number f baths -------- Lot size ................................................. .....:... Water Supply: Public system El system ❑ Private Depth To Water Table ........ ft. Character of soil W depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ s Previous Application'AMade: (If yes,dote--------------------) No ❑ 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.) _ Septi ank: Distance from nearest well--- � ..Distance-from oundation_J,49.------------Material----� •�i�l.r' 'moi No. of,.com artments.-... Size. .° ` -__1 �/ -�Li uid de th....- .. il Ca acit '- P ----------- q P. P Y�f..... r •- Dispos field: Distance-from nearest�w9ell.- '..._Distance from foundation_.._U .......Distance to nearest lot line_��?........... Number of lines---......Z--.-.-..-.._-------Length of each line..- .j:7'1e�.".Width of trench..-.6 ----------------------t Type of filter material�� W_ -,Depth of filter material----- '- Total length..= ..�..._..----- .---- -- _' .11 Seepa Pit: Distance to nearest.well- Lia---=___Distance from foundation....f Distance to nearest lot line._....-....__-.- Number of pits..... -------Linin materia l__.f> '�` z ..Size: Diameter-----Y: . 1.......Dept h--- � r Cesspool: Distance fro'm' ell------ ----------Distance from foundation_.----------------.Lining material------------ ..--..._._.._........_- ❑ Size: Diameter-_---° ' ------------------------------Depth----------------------------------------------------Liquid Capacity-------------------------...gals. Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ ElDistance to nearest l8t1in'e------------------------ --------------------------•------------- -------------------------=--------••---------------------------------- Remodeling and/or repairing (describe):-------- ----•--------------•------------.......-----------•----...----.....-----------=-------....----•-----------------------....._------------------- 1 -------•----------- ---------•--- ------------------ -•-• ----------------------•---------- -- ------- -----------------------------....-----...._. ---- ---------------- ----------------------•- --•------------------- -------------------•-------------------------------- -----------------------•--...-------------------------------------- ------- ------- --------------------------------------•---------------------------------•---------------------------------•-----------------------------------------------------...--------------------•------------------------------ 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 nd regulat4en e San Joaquin Local Health District. [! e P '� ---------------- dor Contractor (Signed} i --------------------- �r / l By:-------------- C?f ►� = f-- -- --- --- (Title]---------------------------------------- --------- ------ (Plot plan, showing size of lot, location of systation to wells, buildings, etc., can be placed on reverse side). f OR DEPART ENT USE ONLY ; APPLICATION ACCEPTED B DATE_. = ---- -- - -- ---- ------- ----------- ' REVIEWEDBY----------------- ----------••------------- ----------------------- ------- ------------ -----------------. -.... DATE s BUILDINGPERMIT ISSUED--------------• - ---------- --•-- DATE--------------------------------------- •--------------•---•- Alterations and/or recommendations:--- e.�----. ' - ---- I------.-------------------------------------------- ---------------------- -------------------------------....•---------------------------------------------------------------------------- --.--•--- -------------------•-•....----------...............------. ---------------------------- -.--- ----.---------`---------- ---------».-.--.-...------......_....---..-----------------......_._...---•--------------•----- :Z� FINAL INSPECTIO -- DateA ------•---------- ------- --------- ----- SAN J AQUIN CAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street V� 124 Sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 21A 5-62 ATLAS