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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. :.................. ---- --------- (Complete in Duplicate) �� --- -------------------- This Permit Expires 1 Year From Date Issued Date Issued ____....�1, ..Z�' Application is hereby made to the San Joaquin Local Health District for a per it to construct and install the work he,(ein.described. This application is made in compliance with County Ordinance No. 549. �� •� L /A, •�n.�y JOB ADDRESS AN LOC N-- k -�----1--- ..= ...... 2- y.l ?- -+ ... *- ------ Owner's Na -------- i.s. 9h.?.. •----- ��l f f�C-'i� ----------------------- Phone.... % _ __ __-----•---- r� Address.-•- •._�..Qa 1 °.'.5..-•.7--0---7 jr ------ -------------- -----..------------APS-�7` .6-1/7 � Contractor's Name_l J� ' 9<•-J-rn--•-- ---------------•------- Phone...be,2..... z_ fLf Installation will serve: .Resident Apartment House ❑ Commercial ❑ Trailer Court Motef El Other [3 Number of living units: _ -_• Number of bedrooms _______ Number of baths -------- Lot size .. Water Supply: Public system ❑ Community system ❑ PrivatoDepth to Water TableQft. 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 ❑ INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) 5 eptic T Di tante from nearest well................Distance from foundation--------------------Material-----------------------------------.............. No. of compartments------ ------------------Size--------------=-----------------Liquid depth--------•----- - -------.-Capacity-------.-----•----•--- osal a d: Distance from neares well...{._Distance from foundation...:_ _.___Distance to nearest lot line...._t��.. jt Number of lines______ ___ ___ ___ --_-_-_---Length of each line�49 I- w'_----Width of trent `_"t-.��_----____-__ Type of filter material _. Depth of filter material____ / ___ .0. otal length___ Q�.......................� Se a Distance to nearest well_ _____Distance f om foundation---Z_..Distance to nearest lot line...>e .. Number of pits._____------------Lining material----- _ _____.Size: Diameter__._.ff d9"_____.Depth____.� r_______--_- Cesspool: Distance from nearest well_________________Distance from oundation----------.---------Lining material-___________---___---------__-----_-_ ❑ Size: Diameter--------------------------- ------Depth----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-_-___-_______________-_________.___.. ❑ Distance to nearest lot line--------------------------------------------------•--•-------------------------------------------•------------•--••----------•---------------- Remo elfin and/ r repairing (describe):---- --------------------- ------------------ �� .... ,, --- - I her ----- ---------- ---------------- --••----------- -------------------------------------------------------------- I -------------••-------- --- eby ce 'fy that I have prepared this applica ion and that the work will be don in accordance with San Joaquin County �6 rdinan, S laws and rul and regulations of the San Joaquin Local Health District. (Signed ... ... ....... ..l ;: vl-:a------ ! -------------------------------... n Contractor) ------------ By:------------------- ---•----•----------------------------------------------------------- - (rile)------------= (Plot plan, showing size of lot, location of system in relation t wells, buildings, c., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----'- ---------------------------------------- DATE- / ATE REVIEWEDBY------------------------- ----- --------------- ---- -•-• DATE------•--------•- ---- BUILDING PERMIT ISSUED ----- mmAl4erations and/or recommendations:_ . U �__._._...._ (K. - -•-)ATE --_-,J.1--V- ---Ejr-L�-••----•---------••----------.. ---------••-----------------------------------------•--------•-----------------------------------------------------• ------------------------------------------------------------ ------- --------•-••--------------••---•---- .......... ........-------------------------------------------------------------------------------------------------------------------------------•--..---------------------------------------------------------------------- -------------------------------------------- 00 1 FINAL INSPECTION BY: --- --------------- Date- `fir1 , %-- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 Wee1>0dk-Street' 144 Sycamore Street } 205 West 91h Street Stockton,California Lodi,California Manteca,California �i Tracy,California ES 9 REVISED S•69 2M 5-61 ATLAS ��