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FOR OFFICE USE: ' •-------- --------------------- --- ----------- APPLICATION FOR SANITATION PERMIT Permit No. ... (Complete in Duplicate) 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 construct and install the work hereindscr described. This application is made in compliance with_Count.y... rdinance No. 549. j �Z'— JOB ADDRESS AND LOCATION. ...5_�3Z1 -J,Uia_ ss .....[-� �? ..-- � IA1 . y► Owner's Name--•-••--91.�.7..�-fAKD..----AI1 N-Wa_..... ....:............. - Phone. Address--------- .......I..4_a----RQX...._--70------------------------_ --------------....••-•----•-- Contractor's Name...----0__WWE .�9 --------------•-•-------------------- ---- --------------------•------------•---•-•--------•---...... Phone----------------------------------- Installation will serve: Residence eApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .__-. Number of bedrooms � Neer f baths ILot size -_._.�Q___,�_.__` 5 -----•---------------- Wafer Supply: Public system ❑ CommunitW�Gav t ❑ Private Depth TO Water Table .. ft. Character of soil to a depth of 3 feet: Sandel�❑ Sana yLoamClay Laam ❑ Clay ❑ Adobe❑ Har an ❑ . Previous Application Made: (If yes,dote--------------------) No New Construction: Yes �a ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION'AND SPECIFICATIONS: j (No septic tank or cesspool permitted if public sewer is ava!Qsble within 200 feet.) Septic Ta Distance from nearest well__-. 0-__-Distance from foundation---- ------.----Ma erial_--. ,pQo ? No. of�compartments-------�-------------Size__�.X_��_X--�-�----~__Liquid depth-___T�--------------------Capacity. .I�p�..... ' i Disposal Field: Distan�e�f from nearest well Distance from foundation.__j9_---_-...Distance to nearest lot ling... .......... ®� Number of lines----------- ----------------Length of each line-/ X-1-017 .Width of trench......1f?..-__---- Type of filter materiaL- 4n --.Depth of filter material_._...1!9-----------Total length------------ --_-.- t ¢urr•-. �s Seepage Pit: Distance to,nearest well.i ..--Distance from foundation....................Distance to nearest lot line--_------------ tNumber of pits_ _-t - LsicA material-----------------------Size: Diameter-----------------------Depth---------------------..--_-.--- Cesspool: Distance tom nearest well-- ------------Distance from foundation'"----...-_......Lining material-----------------------------------N } ❑ size: Elia titer-----------------------�---------•-Depth--------------------------•---------_-------.-----Liquid Capacity---.------------------------gals. Privy: Distan efrltom nearest wel---_-� -----_ Distance from nearest building------------------------------------_-... ClDistance Ito nearest lot line----:-------•---- --- ---------------------------------------------------------------------------------- -.--•--- g / P "'�" ' •---------------- r ------------------------- ---- Remodelin and/or re arch descriUe - .z*'.r .� 4"- -------------------------------------------Y- ------_-------- --------------- `------ --- - -• --- -_-- ------ - ``�=_--------- ---•--- ----------------•------- - hore b c fy at I h e repar this application and-that the kork will be done in accordance with San Joaquin County ordinances, la , a r s an re ations of the San Joaquin Local Health District. (Signed ----------------------- q..-`��-------•------- (Owner and/or Contractor ` - :'may :. _ ,_ Title SY�----------------••---------- ------•------•-----------------•--------------------------------•------------------ .-----------{ = -------------- (Plot ------== (Plot plan. showing size of t, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------7-►13,C)-----------------------------------------------•--------------- DATE..._ '----I7_""4�--------------------- DAT REVIEWED--BY-----—-------•-- ------- �. ---- -------- BUILDING PERMIT ISSUED--------------------------•--------------------. --------- �=:=:Fg--------_._.-�-.-�_�:__x DATE------------------------------------------------------•----- rttJ€ifrytV r --------•-•----- Alterations and/or recommendations: -------------•------------ -------------•--•••-----------...----._......---•-•-----••---....-----....--- -----••--•-------.. ------------------ ---------------- ------ - --•------------- -- --- ----- .. FINAL INSION B Date------------/ ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strut 124 Sycamore Stmt 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS `