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LFOR-FI E USE: t ------------------------------------ ------------------ 15- - i APPLICATION FOR SANITATION PERMIT Permit No. r : ...._...L. .`. ---- ------- ------------ ---------------- -------------- (Complete in Duplicate) 4 Date Issued - ---------------- - ______________________ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construe and install the work herein described. This application is made in compliance with County_Ordinance No. 549. 7 JOB ADDRESS AND LOCATION_f_,_1',4/.-:.-AV___-__��-- ZA_r..... .------- Owner's Name...... rk ------- _001- -- ------- - ------- Phone.................................... C .................................. y�� - ----------------- --- - -- --------------- --- Contractor's Nerve r. = --•---------------------•--- Phone.,�.4.�42—- f Installation will serve: Residence Apartmen+e_ ._ ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ JAS Number of living units: ._,( ............... ti ____ Number of bedrooms _ " ___. Number of baths .�__ Lot size ___/s5 ��C_-a�.�.-.Q •- �. Water Supply: Public system ❑ Community system ❑ Private Lg Depth to Water Table ________ ft. ) d Character of soil to a'depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: (If yes,date..."----------------) No New Construction: Yes& No ❑ FHA/VA: Yes ❑ No,kT TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) " Septic Tank: Distance from nearest wellp...-s Q Distance from foundation----�v�_.-------Material.__________ _______ _______--______________- vL _"__-____Size1QX0__ "d_-Liquid depth-__.____---___-_____Capacity,/ _ No. of compartments__"___. ""_-_-_ ®- Disposal Field: Distance from nearest well___S _"""Distance from foundation__- �_____.__.Distance to nearest lot line._ ...... Number of lines 17. Length of each line____ ____� Width of trench.__...ce7�_"�___________ J g Type of filter material__._. ___Depth of filter material___I/P-___-----dotal length Ct Seeps a Pit: Distance to nearest well_ -_-.-_-_Distance fr m fo ndation_.lQ__r___..Distance to nearest lot line___.. k w Number of pits-____-•,9________-Lining material---� __.Size: Diameter____2---r___-Depth_____.a�` _r____.__ I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------............... ❑ Size: Diameter-------------------------- -----------Depth---------------:� Liquid Capacity..........................•-ga Privy: Distance from nearest well-------------------------------------_____-------Distance from nearest building----Z--4---- ❑ Distance to nearest lot.line--------------------------------------------------------------------- --------------------------------------------------------E----------- r ------------------------------------ ---•--•---------••--------------------•--------•-••-------_-•-•--__------ � Remodeling and/or repairing [descr�be):________"__________________________ " ---------------------------------------------------•----------------------------------_-------------------•---------------------------•-----------------------------------------------•--------------------------------------- hereby certify that I have r , •-- --------------•------------------------------------------------------------------------------------------------------------------------------------- - f y y p spared this application and that the work will be done in accordance with Sen Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f j {Signed} --------- ---------- -- =----------------------------- --•-------------------(Owner and/or Contractor) -By:. .... / = c- __ (Title) =__.-.-:.-_____` Plot lan showing size of to ocafion of s stem in relatio o�si in s, etc., can 6e placed on reverse side). ( plan. 9 g I FOR DEPARTMENT USE ONLY ---•-----•--- ATE-•----- APPLICATION ACCEPTED 13Y —C;-.617l�••,,7•- -- - ----------- - - - --- - -- REVIEWEDBY - = --••--------------------•-------------- DATE-------------------------------------------------......_.... BUILDING PERMIT ISSUED---------•-•-- -----------------------------------------------------------------------_----------- DATE-------- - - ------------ --- - Alterations and/or recommendations------------------------ ---- -------------------. ------------- ------- -- -"- - 6 =f 7---------� ------------ --- ----------- ---•----••---------------------------------------- -----------------------------------_-------------------."._...............----------- -------------------------------- ------- ------------------------------ ------------------------------------------------------------------------------------------- -------------------------------------------- s 7 FINAL INSPECTION BY:_-_-" .-." - _ ______ Date----7----/----- 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wed Oak Street 134 Sycamore Street 205 West 9th Street Stockton,California I Lodi,California * Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5.62 ATLAS y t