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FOR OFFICE USE: 1 , w Zla Q. APPLICATION FOR-SANITATION PERMIT Permit No. .........C��...... -- _ ---- (Complete in Duplicate), _ � Date Issued ....................... - This Permit Expires 1 Year From Dafie Issued" G= - Application is hereby made to the San Joaquin Local Health District,fo__r'ka permit to constrdct and install the work herein described. This application is made in compliance with County Ordinance No. 549.1, / JOB ADDRESS ANnDCATION. ...__ _79_�--------------- ------------------------ •-• / ..--••-•..................••--••-•...••. Owner's Name- 1111 ------- �i ----------------------•-•-------------- -------------•- --------- Phone----------------------------------- Owner's Name- --------- - - ...........--...•- ----------------- -- --•-• -----------------------...-•----------------•- ---------•---- •-•- E Contractor's Name----_------_-_-•--_-----... --- -------V f= ----------------- _..... Phoney �� . .... A Installation will serve: ResidenceApartment House Commercial Court ❑ Motel ❑ Other ❑ LL � � Number of living units: .-/-- Number of bedrooms ________ Number of baths 6_tot size ._--.1_Q-C�..._,lL00./ ................... Water SuPP1Y� Publics stem ❑ Community s stem Private ❑" De th to Water Table*, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ SandylLoa;`❑—C-lay'L-oam-❑--C lay [I Adobe Hardpan ❑ Previous Application Made: (if yes,date _ s- ----- --) No E] New Construction: Yes [-INo), �FHA/VA:Yes ❑ No❑ d at�• { . TYPE OF INSTALLATION AND SPI=CIF1 ATIONS: (No septic tank or cesspool permitted if public sewer is,available within 200 feet.) " ti k; Distance from nearest well_________________Distance from foundation_'------------i'....Material-._____________.-----_-_-_---------------------- No. of compartments----------- --------------Size--------------------- -•--- Liquid7dept1�....... -----------------Capacity....................... a Distance from nearest well------------------Distance from foundation.,':......___._.,_..Distance to nearest lot line................. Number of lines---------------------------------/Length of each line-----------1-------__`_..Width of trench................................... Type of filter material___________________Y?___Depth of filter material...-_ --_______L Tottal length.......................................... Seepage Pit: Distance to nearest well _ _ __'_.:.__Distant m foundation.. �?w--. 'st c�rto nearest lot iine�__. .__.. ®� Number of ------------Lining material- Q. ._$ize: Diameter___ _.._____Depth_____ __________________ Cesspool: Distance from nearest well_________________Distance from•foundation--------------.-----Lining material------------------------------------- 0 Size: Diameter- -----------------------------------.Depth------------------ -------------------------Liquid Capacity-----------•............ gals. "__1. Privy: Distance from nearest well-------------------------------------------------Distance fr'bm nearest building-----..---.---------.--.--.-.--..--------. ❑ Distance to nearest lot line------------••--------------------------------- ---------•------------------------------------------------------------------___-------- Remodeling -- - Remodeling and/or repairing (describe):-----------------------------------------------•_......----------------------�-------------..._...--•---•---------•------_------ ................ fes' ----------------------------------------------------------------------------------------------------------•---------------•--•------------------_:.__.....------------------------•----•--.......-----------------1111-------• t. ----------�- ----------------------------------------•----------------1111_.-----•- -----------------------------------•-------------.-- ----•-----------------• f:-- I-,--,'----------------------•-------------------••----------••----• ------..1.1..11----------.------ ._1 hereby certify that I have prepa ' �' application and that thelwork will be done in accordance with San Joaquin County_ ordinances, State laws, and rules and t atains of thg an Joe in Local He Ith District. . Y ; _ wner and/or Contractor) - -•--••-------- (Signed)-------•--1111------- ---- ---- - - r-------- -- - ,..�.._ ----_ �- B • ------------------------------•--------- ---- -- ----------------------- ---------------- •-• ' (Plot plan, showing size of lot, location s to in relation to wells, buildings, etc., can be placed bn reverse side). �i FOR DEPARTMENT USE ONLY ' _DATE-APPLICATION APPLICATION ACCEPTED B ---- ��R -- .o ..._ �. REVIEWED BY-----------------• ---•-• •• �. .� - - --_-- --------- -------- DATE BUILDING PERMIT ISSUED------ -••--------------------------------------------------------------• ---------------------- DATE-------•--------- - ---- Alterations and/or recommendations:.__-r` - ---- -✓1 ---- � - ------- ----------------------------------------- ---_ _. ----------------•------------------------- -- .. - -,<,.,- ._ -------------------------------------•--- ------------------------------ ........ ------- ---------------- ------ 3 -. - --------------------------J_..__-____-.-_----..._______.--__-__________ -------------------------------------------------------------- ----------------------- ......7- •------- --------�-------------------------------------------- • ...-----••---------------•-----------------------------------•--•------------ / f' FINAL INSPECTION�BY:.. ;� �'Y -•--•� ---Date-:... ��`—!'---------- �l SAN JOAQUIN LOCAL HEALTH DISTRICT i� t 130 South American Street 300 West Oak Street 124 Sycamore Street, , 245 West 9th Stmt r Stockton,Coliforola Lodi,California Montwea,C611fo nic , '` w Tracy,California E8 9 REVISED 9-s9 2M s-61 ATLAS