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..................................................... �1 ......................................... APPLICATION FOR SANITATION PERMIT Permit No. i:. ..7.../. _ -----------------------------------------------•---- (Complete in Duplicate) r ` X' ?% This Permit Expires I Year From Date 1 e Date Issued _._.__.__..1 _... ..................................... ._........._ �/'j--oho-- � Application is hereby made to the San Joaquin Local Health District for a permit nstrucand install th work h This application.is made.in-compliance with County Ordinance No. 549. JOB ADDRESS AND LOCA4 TION.- S ---�'On P l><sn o Owner's Nam __ o I _ .� -•- - •- -----�!f1.-�-,�f--..4C .----•--•--- ----•--- ---------------------••------------••------ Phone.---•-•---•---- Address__....... - ..-•-------------- --- ------------------------- O E Contractors Name... --------------- ......... Phone Phone.--•-•----•-••----...._..._...._ Installation wig serve: Residence ❑ Apartmen House ❑ Commercial (X, Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ........ Number of bedrooms ........ Number of baths ........ Lot size .............. ..._......... Water Supply: Public system Ej Community system ❑ Private 2 Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam Clay Loam Cj Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date.......... .........1 No ❑ ;New Construction:IYes.� No ❑ FA/ es ❑ o ❑ HVA: YN TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SAptic Tank: Distance from nearest well----Sd....Distange from foundation-----1-Q........Material--__ No. of compartments_._. ............../.Size _.: :, ./r S.___Liquid depth____ ....... ..........Capacity. I.......... Dispo;pI Field: Distance from nearest well... __Q. _-._Distance`from foundation......Ld........Distance to nearest lot line..,,, ........or +(1T( Number of lines............Z-------------- Length of each line........IS!...........Width of french....A----------------- .......... ii Type of fitter material_.. 1►-4��C, .....,Depth of-filter material----- length-------/,5'D...i................... �� Seepage Pit: Distance to nearest well......................Distance from foundation....._..............Distance to nearest lot line................. . ❑ Number of pits_________________._,Lining material------._.a-------------Size: Diameter........................Depth..._.__.---_----__.--_-----_-_--_ Cesspool: Distance from nearest well.....:...........Distance from foundation---.---------------.Lining material...................................... ❑ Size: Diameter----------------------------`......... Depth.............---------------------------------------Liquid Capacity...................... .gals. Privy: Distance from nearest WWII---- ----------------------------------- -------._Distance from nearest building..........................I........... .._ ❑ Distance to nearest lot line................................ ------- -----..-..----...----.-.-.-•----•----•-----•---•------•----•--------------------............... 1 ' ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------...--.y-------------------------------------------------------------------------------- ............................--------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County " ordinances, .S ate laws, andles end regulations of-the San•Joiquin Local Health District. t (Signed).. . .-- ------------------------------------------------------------------� , r Contractor) By:.• -`kt-tia. `--- . ..........J .. 1... -(T`rtle)-------------------------- ------------- --------....... (Plot plan, showing size of lot, location of system in relat n to wells, building's, etc., can be placed on reverse side}. ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------- ---------•----- DATE.--�-.y r �-G Z'=---------------- - REVIEWEDBY--------------------------------------------- -------------- ------- ------------------ ------•------••----------------------- DATE---------------....--------•.................................................... BUILDINGPERMIT ISSUED.................................................... -------------------------------------- .......... DATE.------------------..---------------.---------- ----------- Alterationsand/or recommendations:...................-......................................-•---._.................................................................................... ---------------------------------------------------------------••- ----------------------------------------------------•---------------------------------------------------•---.....-------------------•---------------------- ---........------------------------------------------------------- . ---------------------------------------------------•--••-•---•-•---•••••-•-•-•-•--....._._..----•-•---•----••••••••••-••-....---••-••-------•.....- •-------------•--•......•.................... ..........................-..-----------------------------------•-----------------------------.-------------------------------------------.•..•-.-..-•-------------------------- --------••-•----•-•-- ..................... ...... ..............................•••••--••••-----••.._.......---•-•-•---••-•--••----------------•-------•....---.._..._......................--•------------•••---------•--. FINAL INSPECTION BY -------------------- Date_... .....................�6 v SAN :IOAQUIN1OCAL HEALTH DISTRICT.,IN N l 130 South American Street 300 West Oak Street Com' 124 5ycamori Streel* ` 205 West 9th Street Stockton,California lad],California Manteca, California A Tracy,California [S 9 R(VIL[D 8-69 8M 5•61 ATLAS