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----•----------------------------- ----------•••......-- .............. ........................................................ APPLICATION FOR SANITATION PERMIT Permit No. y --•----------•------•-- .......................... (Complete in Duplicate) ...................... ................................ This Permit Expires 1 Year From Date Issued Date Issued '-" •'3 _lr.?i Application is hereby made to the Sen Joaquin Local Health District for a permit to construct end in 0all the work herei described. This application is made in pompjiance with County Ordinance No. S49. ZZ p•7O. n �� F. AJ i C.E t - r JOB ADDRESS AND LOCATION,_ D_,Et I�!L } p �O�T'_W_ _A _.... 1.11!�!_ _.._.__.._.......___._. y�/ ................... Owner's NarneQ - a 9f----------•-•-1-<.P..E7A)J �4 ......... .. : 3' Jib Address-----__n7K.-I... 13-0—k------3 .•� TE _. •......_� - _M!.`Phone Contractor's Name...D.4' " -- •-- I----•--------••-•--- •--------- -------------------•---•`-...� Phone.................................. Installation will serve: Residence Rr Apartment House ommerciel ❑ Trailer Court•❑�M tel ❑ Other ❑ Number of living units: ...1... Number of bedrooms Number of baths, Lot size _� �'��-_------------_ c Water Supply: Public system ❑ Community s Q�Prl ate Depth To Water Table _ � Character of soil to a depth of 3 feat: Send Gravel ❑ endy Loam❑CFa'y Loam ❑ Clay ''" dobe❑ Hardpan ❑ r Previous Application Made: (If yes,date.............1 .... No� New Construction: Yes �KTo ❑ FH /VA:Yes ❑ No d TYPE OF INSTALLATION AND SPECIFICATIONS: '•' \ (No septic tank or cesspool permiffid If public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well._► ......Distance from foundetion-.---..-----_.:._.Mat ri I.. .. ...._.. c No, of comp6rtments..._.... ..,..,,_....Size' ._ ..��._-___Liquid depth_.•...... ... /-.__..Capacity.... Q05 Disposal Field: Distance from neare!st well._--!;- .•_Distance from foundation....lQ.! .,.;,Disten� to nearest lot fes• �.,y ?� Number of lines__....1-._-----------_---------Length of each line......./p._..__. Width of trench....... 'fyp�of filter materiel.... VCX,_Depth of filter material....------ a T�_.Total length....../0.-!................. Seepage Pit: Distance to nearest,wsl{r..-rx�.Distance.fFom.#ounde#ion..4-0- Distance to nearestIpt line.... [� Number of pits_......---------.-_Lining materiel ��.}�..- Size: Diameter-19.X34.1.Depth...[.-._......_--------- Cesspool: Distance from nearest well.................Distance from foundation....................Lining material........_._...._....__-. _._...... ❑ Size: Diameter........i----------------------_-----Depth--........... , -�r Liquid Capacity----------..............•-gel Privy: Distance from nearest well.........................................:-t....._Distance from nearest building.......................................... 111IPS f Distance to nearest of line..................... ----- .•---•___-- -••-------.•------••-----_-.__. Remodeling and/or repairing (describe .•..................................................... .........-....................................................._ ...---....•-•.................................................................. ...................._�_.._.. ............._..-•••-•......••-•........ -------------------------......................................... _....._.................---------------------------------------•---•----------------------------- .. - _ - - ... =----------------------------••--------._...---...._.................---.............----....-- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------- G--•-----.��✓rkZC:P------------------------------- �' --------------------------------------(Owner and/or Contractor) By:........DP - .............--•-• (Title) -.......................... (Plot plan, showing ut a of(ot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY........ tO r_.•---------------------• ---------------...................... DATE----•-fa t REVIEWED6Y................•• •----••----•----•-•-----•-••--•...-•--•••---•- ... - .... - ._._ DATE_.-------- - - -----•--- BUILDING. PERMIT ISSUED..._----------------------- --- .._--- ..:__. ... :::, DATE.:---•••----..:----••..........--....................... Aherations and/or recommendations;•-•............... - -:3•�•�t-4:- ------- ... - I"i ,`i �3 ---•-------•.....................................•........—................................................................................................... _................................................ .................–............................................................................................................._................... .... –.............----------- --•------...-••-----•-•-•.._....-•--•...-••---•••••-•---•------•—•---•-•-•......_................---•–......-••--- FINAL INSPECTION Date------lf_-1.-._IC7.��.................•--•.......... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 south American Stnret 700 West Oafs Street 124 Sycamore Street 205 West%Street Stockton,California Lodi,Coltfernia Montem,California Tracy,California ES 9 REVISED 6.39 21A 3-62 ATLAS