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FOR OFFICE USF' r- __---..- -.--_---_---------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. ...-4f Q..-2 --------------------------- ----------- ------------ (Complete in Duplicate) I / --------.--- This Permit Expires 1 Year From Date Issued Date Issued ...................a�. 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 A O ATION---- -- �✓-- ------------- --flh`r .¢ ---•------------------------------------•----------------------------.._.._..---••---.....------. Owner's Name------ --•-•- _ ------ Phone.................................... Address........................410. y.... -- - - - ------------................-----------------------------------------------------------...-................................ Contractor's Name---------- f -- ----'t' ¢ /------------------------- Phone........ Installation will serve: Residence C] Apartment House Er-C-0mmercial ❑ Trailer Court ❑ Motel ❑ll Other ❑ Number of living units: .., Number of bedrooms&--. Number of baths Lot sizeW_�-f._._. Water Supply: Public system gKocqommunity system ❑ Private ❑ Depth to Water Table ft. . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(90"A'ardpan 0 t Previous Application Made: (if yes,date--------------- ----l No [g-,New Construction: Yes ❑ No 2?, 1F_HA/VA-. Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S Rtic Tank: Distance from nearest well___"____Distance from foundation-------------------_Material................................................. No. of compartments---------------- -----Size--------------------------------Liquid de th__.______--.____.-________Ca Capacity Disposal Field:, Distance from nearest well-------"--------Distance from foundation-.,e_0'iQ__i------Distance to nearest lot line...w"F_.�.... 5Wtf,71,111y Number of lines____;___ _______ _______Length of each line_._._!_____ " Width of trench...9-------•__________________ \� Type of filter materia�"e 4__Depth of filter material____ ______.--Tafel length___,lei__._�________________________ G`Ij Seepage Pit:t Distance to nearest well ____""'"---------Distance fr m foundation_... .e_�_.Distance to nearest lot line---_......_.. w� Number of pits------/------------Lining material__&09:�__ ._Size: Diameter_1KP --____Depth%AjO . Cesspool: Distance from nearest well----------------_Distance from foundation--------------------Lining material•__._.-----------------------....... ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--..........................gals. Privy: Distance from nearest well-----------------------------------------__------Distance from nearest building___..___ _..____._---------__________- ❑ Distance to nearest lot line.--------------------------- ...... ---- -----••-----•---...__.--•--- ------ 4dRemodeling and/or repairing (describe):-----------------------lq - ----•------•-----••-- - •-----------_----------- i ------_..------------•------- ---------------•---•-------- = --.......:.----------------------------------------------- .; ------•----------------------------------------- -------------------------------------•----------------------------------------------•--•---------•---••----------------•--------------------•------.-.-•.-------•-•-------- I 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 ules and regulations of the San Joaquin Local Health District. __ __.___ r Contractor (Signed)-----------••----- -- - - ---------•• - - -- •---- ----- - ------- � -�------------- ---- -•---• •-;-----------------------� { 'net-sl� I • Ti+le (Plot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT,USE ONLY f APPLICATION ACCEPTED B = -------------- }---- DATE------------ �"Z b -------------- --- REVIEWED BY---------------------- ----- ------------------------------------------------I----------------------------------------- DATE ----------------------------------------------------------------------------------------------- ----- BUILDING PERMIT ISSUED....--•---• •-----------•------- ------- •---------------------------------------- '--------------- DATE----------------- Alterations and/or recommendtions:_ _�02_ _..�_�_Z.____ _AA �,o__• 2, ._�_�Cs,.._............e....'.. ------ - __ _ __ _y.l- .. . ----------. .-z.�---�-�.-- ------- - --------------------------V-------------------------------------------- - ------- . - - FINAL INSPECTION BY zn_, -L.- lea-r+�✓ Date ....--------------•-•---•-- �/ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street" 300 West Oak Srrost N, 144 Sycamore Street` 205 West 9th Street Stockton,California Lodi,California Mantua,California Tracy,California ES 9 REVISED 8.59 291 5-61 ATLAS