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FOROFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. "....... __.: ____.. -------------------------------------------------------- (Complete in Duplicate) ----- This Permit Ex fres 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 described. This application is made in compliance with County Ordinance. No. 549. A,16NT�Qf�. JOB ADDRESS AND LOCATIONr_.d IN� ---=R-I � OwnersName t � d ---- ----------------- - ----------------•----------------------------- Phone ---••--------• k Address........---•- r * x..........70------ Contractor's Name..rn�gNTE�---..? �-----------•-------------- -------- Phone-----••---••--•----•-••- Installation will serve: Residence 21 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ��• } ""_--- Lot size ... -h.E c_ -____-- _•-•- ;t Number of living units: _,"_". Number of bedrooms Number of baths _sY_- VAH*r Supply: Public system ❑ Community system ❑I Priva to E]"'Depth ro Water Table " ."_ ft. �6 Cha raclfF tolh+o a ep et and Gravel Sandy Loam © Clay Loam 0 Clay ❑ Adobe❑ Hel en❑ Previous /ARP inA W+- :, `_r+.. } N ,, Ljtjr',.i:..r'i�srisrruct�orr' R#S'E- Mo F Ifi)VA:�P'e5 �' i1p _ �,. Z.f � � ...� TYPE 'OF INSTALLATION AND-SPEC IFaCA_TICiNS: (No septic tank`ot� cesspool permi+ted if public slistan r is available within 200 feet.) I Septi4 mak: Distance from nearest well_---_-_._-_---. ce rom _ foundation-------------- A No. of compartments------------------- -----Size----------------------------- Liquid deRth -M. a_.t.e""r.i"a.l."" -_.."_._..._"C.""aPa-"cit..Y............. "- S1 - -.. �y DIsposal Field: Distance from nearest well---- "."Distance from foundation..._Z0--.----Distance to nearest lot line__ .......... — lir Number of fines__.�""_�- -------------Length of each line........ ...>�.--------------Width of french-------�x ._."." ------- Type of filter material._.- d-( V� Depth of filter material------.�-�"_."----Total length-----------2_-_----------------� Seepage Pit: Distance to nearestiwell----------------------Distance from foundation--------------------Distance to nearest lot line-------------. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-._...------------------Depth--------.----------------------- Cesspool- .-•---•--------------_Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- EJSize: Diameter-------------------------------------Depth.------ -------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------- --------------------------- ----:._Distance from nearest building-----------------------------......... -.. Cl Distance to nearest lot line----------.-""""'".--__---_.-.__"-"-"-"---_---.-__ Remodeling and/or repairing (describe)--------------------------------------------------...•---------r-----••-------- --••---•---------•------------•-•----------------------------•---- ------ --------------•---.._.------------------------------------------------------------------------ ----•---------------------------------- ------------•-••------------•--------------------------------------------•---------------------••---------•-- ------------...-----•-------------------•----•----------••--•------------------------------------------------- I hereby certify tha+ I have repared this application and that the work will be done in accordance with San Joaquin Court ordinances, 5taaws, and rGl7a�ion gula 'ons of +he San Joaquin Local Health District. ` !!� (Signed} c- ------------------••------• !G �' .................. ------- ..'— Contract ---------------------------------------------------------------(Owner and/or B ' Title Y• - or{ ----------------•-----..._..- (Plot plan, showing size of lot, If system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -1---' ��-`------------------------------- ------------------------ DATE. --.-`----1 -------------- REVIEWEDBY---- ---•--------------------------- -------------------------------------------------------------------------------•--------. DATE BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------- ........ DATE t Alterations and/or recommendations:-"------------------------ ---------------------•-"•------------- -----•--------------•--•--•"---•-•---...._...... ------------------------------ -------------------------- ................. --------------- ----- _ - .-..-. ----------•- ----- ------- ----- ---- - ---------------------------------"...-..--------------••-------•-•------- -• -------. ------ ------------------------- ----. ---------------------------•---- - --- FINAL INSPECTION-8- 11 U --- ---• Date '�..... ------------------------- SAN ---------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS