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FOR OFFICE USE: ; r --------------------------------------------- ----- __..__.._._ APPLICATION FOR SANITATION PERMIT Permit No. 7e", (Complete in Duplicate) 7�� "- -----------------------------------___ ______�.:� -- {. This Permit Expires 1 Year From Date Issued Date Issued ...................._. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in^compliance with County Ordinance No. 549.. JOB ADDRESS AND L CATION_...l. -- - ------------ -- � -••---S Owner's Name--__--- •-•-- -------- ---�4�----- --- - Phone---................................. - ------------------------------------ - Address.------- - .: ............. --------._.-.._..---------------------------------------•---•----••-•-------••••----- �r Contractor's Name........ ----•------------------•--•--- ----•--------•---------- Phone.............. Installation will serve: Re-sidence.[R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A_. Number of bedrooms ---:71t Number of baths __r._ Lot size ........................-------- Water:Supply: Public system ❑ Community system ❑ Private W Depth to Water Table L.P f+. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam (� Clay Loam [3 Clay C] Adobe❑ Q Hardpan Previous Application Made: (if yes,date--------------------}t No X1 New Construction: YesR No ❑ FHA/VA: Yes ❑ No ❑.i TYPE: OF INSTALLATION AND SPECIFICATIONS-1 q, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ~�l SFptic Tank:. Distance from nearest well_=_57A__1...Distanse from foundation____J_ !-_---_-.Material--- __-_._ ._-.... No. of compartments__.___`'�_____________Size_*0rKA_4B____.0------Liquid depth_-------I--------------Capacity.../. ,Q.T...... Disposal Field: Distance from nearest well-__57$.__--_._Distance from foundation.. _0._----_------Distance to nearest lot line .p • lin _ Number-of lines:�:___�________________ _____ Length.of each line----- ---------------Width of trench----- - - -------- V-0 ____--_ Type of filter material --Depth of filter material____ y_________To+al length-------��__Q'______________________ Seepage Pit:' Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- 0 Number of pits------- -------------Lining,material-----------------------Size: Diameter------------------------Depth_------------------------_------- Cesspool: Distance from nearest well-----".._..__Distance.from foundation--------------------Lining material.............................. ❑ Size: Diameterr_—---•-••-- -+----_��-...Dept h.:----------- .....-----••--•-•---#-------------Liquid Capacity........................r.-gals. Of Privy: Distance from nearest well-�,_.�______________ ____________________Distance from nearest building______________________________.______.___.` ❑ Distance to nearest lot line-------- --------------------------------------•---------- -------------•------------------------------------------------------------------ Remodeling and/or repairing ',(describe):___._____-------I "-` ----------------------`----------------------------------------------------=---------------------------------------------------------------------------------------------------------------------------------------...------ -------•---- --•---==--------- ------------............-----------------•---•--------•-........................---------------.---------------------------------•------------------------------------------------------ ------------------------------------------------------------,----------------------------------------------------------------------------------------------------------------------------------*------------------------------ ____________________________________}'._k_-_ ___----___--.---_____-_--.-________----___------_----_-____.___-._____-__.-_______-----._.___---_-_..--------.-_-._____-__--_-_____-----__----_.-______________.__.______...._\ I hereby certify thatrl h e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S aws, and les d r ulations of the San Joaquin cal Health District. 4 (Signed)...- .... --•--• - ---•------- ----- (Owner and/or Contractor i -------------- y;..... • --------••.............. .............•••--• •-•----•-__.....••••-------•...----...-----...-•----(rifle)--------- -•-----•------------ ........ ------------- _ -[Piot-plan;showing`size'of lot,'locetion'of system`in relation to wells, buildings, etc., can be placed on reverse side):' 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------ DATE----2-7.2. --4.2-----.------•------------------ REVIEWEDBY-----------------• --------------------------.-------------------_ DATE-__-----•---•----------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------'•----------•---------------------------E ------------DATE••--------------•-------------------------------------------- Alterations and/or recommendations:._.________`________ ---------------------------------------- _..- ...................................------------------------------------------------------ ---------------•-••-•--------•--------••---------•----------------------•---------------------•-...------------------------- --------------------•--•--•---------------------........----------------------------------------------------------------------------------------------------------•.............---.....------------------....----------- f FINAL INSPECTION BY: --- .. .... Dater- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-61 ATLAS