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FOR OFF : ----------------- --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...:�.._ .—�� ---------- ----------• ------ (Complete in Duplicafe) ` ----------------------------------------------------- -- Date Issued ...� / I This Permit Expires 1 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 LOCA N.------ �`�e _-1 / 'i /..lr=t.�.. ... Owner's Name---•-- ------ l . --------•----•---• /.� 'C� lrs//- ---------- / ' ------cG"_ {- , +. one-----._...--•--•-------------------- - ,Address` --......:�..�............... Contractor's Name-_-__:__.` ---- ------------- _- ------ -- ---------- - ------ ................ Phone................................... Installation will serve: ¢ Residence,❑l-"A'—partment House Commercial Trailer Court ❑ ❑ ❑ Motel ❑ Other ❑ Number of living units: ___- °Number of bedrooms __2—Number of baths ---1... Lot size,.._ _ .3 oz- __-._ _ Ater Supply: Public system ❑ Community system ❑ Private [I-15e`pth To Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Ilf yes,date----------------_---) No D ew Construction: Yes ❑ No [D__-FKX_/_VA. Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2DO feet.) Septic.T Distance from nearest well-----------.-----Distance from foundation___________________Material__________-____._._____...____-_..___...___.__._. compartments--------------------------Size-----------•-------------------Liquid depth---------------------- -Capacity ---------------•--..--- Dispos� Fi/eld: istance from nearest well_________________Distance from foundation____...-______--___.Distance to nearest lot line..... -------- ❑,a%/� Number of lines________________ ----•--------------Length -of each line-----------------------••----.Width of trench---------------------- Type of-filter material,------------------------Depth of filter material--------------------- •------ --Total length.------.-----••--------------,-•-__-- Seepage Pit: Distance to nearesfMwelL- OP__r____Distance from fou ation._. e r ! �_.____.•____-.Distance to nearest lot line._.___S.____... �^ Number of pits____ _______________Lining materiai___kV_C _' ._Size: Diameter___��` v .. ;- ..----�-------.Depth----ta�.S`..�-----••---..._ Cesspool: DistanCe from nearest well_________________Distance from foundation___._.--------------Lining material_-------.-------- O ❑ Size: D ameter = Depth -----------------------Liquid Capacity -------.-gals. ---------------•-•- Privy: Distance from nearest well __________-------------------------- -------Distance from nearest building to nearest lot line = q-------•-•-------------•--------•------------------- Remodeling and/or repairing (describe)_---------------i��_ s C.. _ ---••--------------------•--••-------------- --- ------------•----•---------------------------- --•----•-•------•---------••--------••--------••-..-----_--•--------•--------•--------- --•-------------•--------•---------------•------------------..--•---------------•-•--------------•--••-----------------------------------------•---------------------------------- f I hereby certify thafj have prepared this application and that-+he-work will be'done in accordance with San Joaquin County ordinances, State law and rules^d regulations of the San Joaquin Local Health District. (Signed)------•--"--- GTS' - ----- -- --------- ----------------- ------------ ------- (Ownerr Contractor) an o By-------------� [r+le) -- (Plot plan, showing' ---- 'si _lo+, to ation of system in relation to wells, uildings, etc., can be placed on reverse side). e FOR REPARTIMENT USE ONLY APPLICATION ACCEPTED BY---------- ---r --- `= y�Y T-----•--- DATE__. •-- - --------- --------------- ---•--------------------------- `.. ---t-•-- REVIEWED BY------------ - ---•---- ------ - ----------------- DATE------. ...--- r ------------------- ------------------------------- UlLDING PERMIT 155UEQ. -- ------ DA•TE...__.._... I Alterations and/or recommendations: r a -�---�>-�--��`--_---•--- - (V.f!,.�eC..+-f�-,left .. + --- *-�------ --� --------- - - --,;;�-------••--••------------•---------- ---------- •--•----. ------ � �f=l . .. _ ------- ...... ✓ ----------------- ------ ---------- FfNAL INSPECTION BY--------------------- - p Date.._..._"_":--- } - Q L SAN JOA UIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Strut 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Californla Tracy,California E6 9 REVISED 8.99 2M 5-62 ATLAS t