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hOR FICE USE: I i ?`� ( PDuplicate) ,1 S..,1 zl) e............................. . . ... .. . .. ...... ..! APPLICATION FOR SANITATION PERMIT Permit No. . .............-..........................-.-- Com lets in / eldi This Permit Expires 1 Year From Date Issued Date Issued ../4..A� Application is hereby made to the San Joaquin Local Health District for a permit to construct in the work herein de This application is made In compliance County Ordinance No. 549. JOB ADDRESS A I N Owner's Name....:.......... .. ...... ..... .... .. ..- ..... .... > _ ............... Phone..�Pv. / z - _ �—� Q Co Nam ' o _..a..` P ��O ... = l...J....1...._ ..c--- Phone- Installation will serve: Residence A artment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ' Number of living units: -------- Number of bedrooms ........ Number of b the ........ Lot size ..(it�i�c�-. r......................... Water Supply: Public sysemd+d ❑ Community system ❑ Private epth To Water Table ........ ft. Character of soil to a depfh:fof 3 feaf: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ ' Previous Application Made:�(if yes,date....................) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or ce spool permitted if public sewer is available within 200 feet.) 1 t5rY�J Distance from nearest well.,/"_--Distance from foun tior�.l.. �_....MaterialAv._:ta-.d --- - 4- �-)-4 No. of cppompartrrrents..�- Size�!X&2!! ., Ligwd depth......6.0.°........Capacity-.Li .. Distance from nearest well./.B.Q.....Distance from founda#ion.--1.C�.�....Di�tante to nearest lot line..--- ..,1.." Number of lines.. ... ............Length of each IineVQ C..,fO-'al/JWidth of trench....... .rte!!,.....-...... e Type of filter material. Depth of filter material..../I..Al--------Total length..........r,- fX-v_............... Q ' Distance to nearest well................... ..Distance from foundation-_--_--------...Distance to nearest lot line................. Number bf pits......................Lining material.......................Size: Diameter.......................Depth...........-..................... e Cesspool: Distance from nearest well.. ....Distance from foundation....................Lining material............-..- ❑ Size: Diameter.............-----------------_.Depth-------- ...... ----•-- � ' - -- -----Liquid Cepecity......-•---................gals. Privy: Distance from nearest well.. .............................................Distance from nearest building _____ ______ \ ❑ Distance to nearest lot line ` Remodeling and/or repairin (describe):......./py... . ...-. `- _----- - .. - q.... ...- --.. ef.r d..l7f.,-..ei-..... .. J' ----------------- ......................-........... ... .. .. ..... 11 .. S + - .�_1.� - ..1j4 = --- -- ...... ... - _-....... - - - _...._ . I hereby certify that I have prepared Phis application and that the work will be done in accordance with San Joaquin Coun y=t:. ordinances, $+af laws, a d -I en regulations of the Se quip Local Health District: ( - -Contractor) - -- ................. (Signed .... ... .. 12 3�..�J/� . _........... '-------... By:... - ...-. - Tithe (Plot plan. showing size of lot, location of system in relati to wells, building , eta., can be placed on reverse side). i OR ARTMENT USE ONLY APPLICATION ACCEPTED gy__......... - :-= - DATE...............�-- ...... ...0 3............... ......... ................. ..... REVIEWEDBY............ 4 - - ---......................... ......................---... DATE......-•----........---........---.....................---- BUILDINGPERMIT ISSUED-1----------------------...................................-........................-............. DATE...................................... Alterations and/or recommendations:............. ......... - ............... ........ - ... -....... --•... - I..--•-------...----.........------.....-...........••-•----------------•----.......-------------------------------------- ..--------- - - -- --------- •------.....----......-...............-----------•- ..............................................d..................------...............-------.......--.............••---------.---......................................---•---- ......--•-......--•-.1-...... ................................ ..............-----...---.....--.---...---------------.....-------------•--•-.....................__................................. ........I............... ............................................ .... .......... ...:............... .. .... .--•--...-............--- _--....... ...........-..........--`..............................--...............--•- ---- FINAL INSPECTION BY:..� - �/� �• �•a ----- �.`-_ _ D........ ate---._................ ...frr..J... .............. ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Ann.d,an Strut 300 West Oak Sant 124 Sycamore Street SOS West 9th Street Stockton, California Lodi,Califernla MaM.W,California Twq,California ES 9 REVISED 0-59 2M 5-62 ATLAS