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FOR OFFICE USE: = �- Permit No. ... 'S� { . APPLICATION FOR SANITATION PERMIT "'" ------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Distract for a Dermlt to cons #u aS;nsta4l the work herein described.. This application is made in compliance with County Ordinance No. 544: CA &A-44' -----•--- •... JOB ADDRESS AND LOCATION.......--_ --7--'�-- V---------- ------------ -- - ------------- Phone------------------------------------ Owner's ----------------•--•------•-------- Owner s Name----------�,75: •.----- •-•-----•-•- - Ct . --•------••-------••--.-•---------------- ---- 1 Address-•---•-----------�.....-- rZ•----....----•... - „r`- --•---- Phone........ ------ =-'==.......•--- Contractor's Name...........-............ E ; Installation will serve: Residence Apartment House Commercial ❑ Trailer :Court ❑ Motel ❑ Other 13 Number of baths. _:_ Lot size •-------- ----• ----------------}.-.- Number of living units: . Number of bedrooms f l " Water Supply: Public system C] Community system ❑,Rrivate� Depth to Water Table _..____- ft. Character of soil to a dep#h of 3-feet: Viand_ Gravel [jSandy Loam ❑ Clay Loam Clay � Adobe Hardpan k tj Previous Application Made: (If yes,date--------------------) No ❑ New Construction- Yes [jNo [I ❑ N ❑ FHA/VA: Yes o TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � Septic Tank: Distance from nea &V.ml id. rest well___: ��____Distance from foundation ..-----Materi'!______________ No. of compartments------' .. +..... $iza _r `Liquid depth_.. � - Capacity t ' nearest well _Distance from foundation____.°�a-.....Dis#ante to nearest lot line.- Disposal Field: Distance from ..._._.. 1 l Width of french---- ..--'�-••----..----- Len th of each line_._____ ---.------•• Number-of lines_______________ __•- -- 9 .i r' � of filter material ........Total length..------_ - --------------- A 1 of filter matenal._._.leC..>?z -.----Depth l � �� .y � Seepage Pit: Distance to nearest well__/G _________Dis#ance ,f m f ndation-_/-�`- •---•Distan�e to nearest lot line..... ..., -� V _`Lining material_ -------Size: Diame#er-.-..73-_.-..-----Depth------�-- -•.•-----••-•- Number of pits-------------------- i Cesspool: Distance from nearest well--:- -..!!.Distance from'foundation.---____-__-..____.Lining material__________________________...........ls. ____--____Liquid Capacity 9 ❑ Size: Diameter--------------------------------------Dep#h$,.....�...�.--------=--•-------------- ,q P #Y---•--...----•--•-----•--.. Privy: Distance from nearest well---------------------------- .... --Distance from nearest building_________________________________________ ❑ Distance to nearest lot line-------------------------- •-•------------•--------------------------- -•---------------------------•-----•-•---•-----••---• ----••---•••---..----- Remodeling and/or repairing (describe):__-___.__ --------------------------_--------------- t .. -------------- .M-------------------------------------------------------------------•-- ---------------------------------------------•----------------.----------- ------ 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 rules and regulations of the San Joaquin Local Health District. r - ••----_----_-------------------------------------------------(Owner and/or Contractor) I (Signed)----•-....__��.._ .�� - -- � By---------------------- -- .a {Title)----------------•----------------------------- -------- (Plof plan, showing size of to , location system in r ion to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- ---- ---- - DATE---------- -- --- - ---- -- •--------- 1 REVIEWED BY DATE-•---•---•--------------------------•••--------------- - ---- BUlLD1NG PERMIT ISSUED----------------------------------------------------------------------------•------------------ ------- DATE---------------------------------------I-----_--------------- Alterations and/or recommend tions: f------------------ . = .--- - -.. ....._ r f ------- -- ._�_..,� ---- A FINAL SPECTION BY:_.. " '�J= ;; ------k ,. SAN JOAQUIN LOCAL HEALTH DI"STRICT - , 130 South American Street 300 West Oak Street 124 Syc more Street- 305 Wast 9th Sued Stockton,California Lodi,California Manteca,California Tracy,California to 9 REVISED 8-59 Std 6-61 ATLAS