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FO OOFFI( Ee,S ,� �...._. .-: �� ------- Permit ala. .__!. -_• ..... /� APPLICATION FOR SANITATION PERMIT ---------------------------- (Complete in Duplicate) Date Issued ..-- /.. - _ - - - This Permit Expires�l Year From Date Issued -------- ---'-------------------------------- Application is hereby made to the San Joaquin Local Health District for a-permi#to•construct'fand install the work herein described._=This application is made in compliance with County Ordinance No. 549_. • .fir`-: JOB ADDRESS AND LOCATION------- 3_s .--------ZiC'%nlv �ar .- !. ----------------------------------------------- Owner's ' -•- Phone. ?'�.----------------••-f._.. �S� ...-------•------••--••-•-- Name.-----Gtli�-----��----•-•--`----=---------�> =-------•------------------------ --•------------------•------....._......---••-------••-_.. 1 Address------• ._.:._ � �---.........�---------••---------------- --•-•-----------•-------- •------- i Contractors Name...--------• ....... ----_ tis/�_�-sc� us�------•-••-----=-•---- _ _. Installation will serve: Residence [+r Apartment House (ICommercial Trailer Court ❑ Motel ❑ Other ❑ i Number of livingunits: ___!___ Number of be :_A-. Number of baths __/_. Lot size � t ( Water Supply: Public system [] Community system El Private Private Depth to Water Table'- ft. . .� Character of soil to a depth of 3 feet: Sand ❑ Gravel El Se Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan r . ....--- y,r qn/A: Yes ❑ No El Previous Application Made: {ff yes,date_..11�d-__-____) No New Construction: Y4eFH No s ❑ ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ! ' (No septic tank or cesspool permitted if public sewer is availabih within 200 feet.) , Septic Tank: Distance from nearest well________________ Distance from foundation..-------------------Material__...___. ------- _..'_i--.....- ..A:""•--•- -- ❑ ex,1sr1W6 No. of compartments--------.................Size-------r--- '- Liquid d��h ==- Capacity ` Disposal Field: Distaf ce from nearest weH._. ---Distance from foundation_ .l._i-._=__...Distance to nearest lot line....: ..:..... L CX�sriN6 Number of lines------------- ------------ ......Length of each line--------- _ --Q-•---- _-.Width of trench_. ., . 4 : tr._.....-••--..._. ' ----- otal leg _. ___:. --+•---- add Type of filter � Depth of filter material__- -Y.$ 1 i Seeps a Pit: Distance to nearest well----1&o--------Distance' from foundation_ _-_1a..._.__Distance to nearest lot line___.SS�_..__._ baa Number of pits.----'_.L------------Lining materia!__ .- j5___-Size: Diameter------ --- --.De th______--_-}., Cesspool: Distance from nearest well------------_....Distance from foundation- _. _-_-__.._.__--.Linin 1E . material-____------_i-=,_...____--____..l.s Size: Diameter- -- - -- Depth---1`------------ -------------------------------.-Liquid Capacity--------- -----------ga --------------• -----❑ - 1 Y Privy: Distance from nearest well-------•------•---=-----------I-: -----------Distance from nearest building--:•.•----•-----•---------•----.. '_._.._. 1 Distance to nearest loft line:--------------------------------------------------- 13 -- •---------- ---------------- - 1 1 Remodeling and/or repairing (describe):------ --= l3 ------------------------------------- ------------- - --------- - -- -- -------------- - --•------•---------------------------------------------4-•----• --••------•--•-------- ------ .--•------•---•---------=----------------•-•----•----•- ------------------------•-;•- ----- •---- --- ---------- --•-- ----- .-------- ------ - z '= I hereby certify that l have prepared +his application and that the work will be-done in accordance with San Joaquin County ordinances, State laws, and rules ands regulations ;of +he San Joaquin Local Health District. " / . '�? ----------------------------------------------------- .(Signed) rand/or Contract - .- '1�1'�?�•.'.. {Owns --- or] 1. I -'- --- ---- ---------- - By:---_----------- `'�_:.'._. . .. ( e] rt (Plot plan, showing sizef lot, location 6f sysferl in relation to wells, buildings, etc., can be placed on reverse side). FOR PEPARTMENT USE ONLY -------- DATE..................... --•= ice" ------------ APPLICATION ACCEPTEb BY_____ ___ ______ G - RVIEWEDBY --------•------`-------------------------------------------- DATE BUILDING PERMIT ISSUED--•-------------••-----------•-------------------------------------••-•------ ----- -- ------ DATE------•-----••------1----------------------------------- Alterations and/or.recomm ndations-------•--- --- _f - - - - --- --------------_ ._ ---------------- �: ------------------ .._... • .---- ---------••---...__ --------------- ---- FINAL INSPECTION BY:. .1.--"--- - - -- ---•-------- ------------------ Date...... --------�j-------- .__.-------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 130 South American Street 300 West Oak Strad l Stockton,California Lodi,California Manteca,California Tracy,California r E6 9 REVISED 6-59 =M a-61 ATLAS l