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I FOR OFFICE USE: --------- ---------------�� ._'�____ _---_._.____' -------------------------------------- II APPLICATION FC R- SANITATION PERMIT Permit No. .�� ------- -- ------------ --------------------------------------------- (Complete in Duplica+el , •� S ------ - Date Issued------------------------------�I�- --- This Permit Expires t Year From Date Issued if' Application is hereby maddl to the Sart Joaquin Local Health District for a permit to construct and install the world herein described. This application is made in'tompliance with County Ordinance No. 549. il O --- �qJOB ADDRESS AND LOG ` 7® ........ ��_ Owner's Name--------(- i ...•---- - ------•---- ---------------------- ---------- Phone----- -------•-------------...--... ------- - --- -��- Address-----•--... . = =` - © + ! �lJ 12.{•• < f Contractor's Name•----......I� - t .-----.. -------- �I - - -- Phone---------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 1 Number of living units: ........ Number of bedrooms -------- Number f baths ........ Lot size ----�'---_�X_�---- Water Supply: Public systal'm ❑ Community system ❑ Private be To Water Table _61 ft. Character of soil to a depth. of 3 feet: an p .I. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam�cj Clay ❑ Adobe" Hardpan ❑ Previous Application Made.` (If yes,date___________________) No � New Construction: Yes 9'No ❑ FHA/VA: Yes ❑ No" TYPE OF INSTALLATION.1AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well----f Q/.---Distance from fojundation----4-r..�-.Material-------____________________ _ ________________-_�j Q �] No. of �Mompartments---------�.----/-.--Size._.d_j°�-----x--'--_�f_Liquid depth--------��"-------Cap pcity---- a`�� • Disposal Field: Distance from nearest w ll_l& af'_Distance from foundatio _____-�__f istance to nearest lot lin Number;of lines_____________ �—._____ Length of each line_, ,,�.q.0_.Width of trench._.--_Z ,I LL 9 `h' .` -p.��! -------------� R Type o ICfilter material.. �hDepth of filter material 1tf_________.Total length_____ •f__,7fi�....._._. Seepage Pit: Distance to nearest welL____1_- __ ___Distance fro foun ation___-_/_p-_.__.Distance to nearest lot line___'j____ __ 29 Numbed - _..of pits----.--"�'C ._Lining material ' -� ize: Diameter----- c --------Depth--(---,).- - 1 Cesspool: Distend from nearest well-----------------Distance from foundation"._-.--------------Lining material-----4-___.-______.________________ ❑ Size: D lameter------------------------•----------..Depth----------------------------------------------------Liquid Capacity....�1-----------------------gals. Privy: Distance from nearest well__.._--________________________________________Distance from nearest building----- ❑ Distance �o nearest lot line--------------------------------------------------------- IE -- -- I� Remodeling and/or p inr�g (describe:-_ _ . f f/�i ---___._.N .------•`"?�` N € --.•-- - ------------------ ---------------------- ------------ ------------------- - -- ��'- --------- 2Q✓ s- -------------------------------------------- -- -------------------- -----------------------------------------._......-------------------------------------------------------------------- ----------------- ---------------------------- ------------------------------------------------------------------ .I. I I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, State laws, andl rules and regulations of the San Joaquin Local Health District. (Signed)...- ----- _-- - - � _ --------------- -----------(Owner and/or Contractor) BY• --- ----------------------- ------------------------------------------------------------------(Title)__.... ----- f ' I plo+ Ian, showing size of I9t, location of system in relation to wells, buildings, etc., can be placed on reverse side). P 9 Y I e). I�. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED, BY `------------------------ ------••---------------------•-----•--- DATE....--e- REVIEWEDBY... =�---- ------------------ --------------------I----------------------------------------------------------- DATE----------------------------- ........... BUILDING PERMIT ISSU0-------------------------- •--- - -------- ------ -- DAT ..----------------- I� / IM -AFterations and/or recommendations:..__._ .,-------- G --- - i .------- -- --------------------------------------- [11 ------------------------------------- -------------------------- ------------------------------------------------------- -------------•--- ----- -._--------------------------------------- -----••------------ --- -----------•----•------------------------- ----•----...------------------------------------------- -------------------------------------------------------------------------------------!M--------------------- ----------------------------------- -� _ ------- ------------------------------------------ I� �(_.� ---------"� ----- �".`�!..----------�----'------- ytt .--` 1F•------ - . .'- --------A---- I - O �! FINAL INSPECTION BY. -- ---------- --- 1 - Date------------ p l.-...-:. .. SAN JOAQUIN LOCAL. HEALTH DISTRICT 130 South American Street i 300 Wast Oak STreet 134 Sycamore Street 20i Weil 9th Street "Stockton,California Lodi,California Manteca,California Tracy,California a_;, 1 ES 9 REVISED 8-59 zM 5-62 ATLAS