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FOR O7 SE: ------------------ S_ -G __2 ��`7 APPLICATION FQR 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;in work herein described. This application is made in compliance with County Ordi No. 549. JOB ADDRESS ' L CATION -- .-.� -- ---------- --------- -___-: - _.- ..� -- Owner's Name--- �-:.---... -------- Phone -2 S7 Address-----------•-----_ -------------------•------------------------------ --- . Contractor's Name--- - --- --(L------- - r t.. {---.... ------ Phon .. . Installation will serve: Residence pa ment Hous ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1_--- Number of bedrooms -1--"'Number of baths Lot size//. Jz--_ _------- ----------- Water Supply: Public system ❑ Community system ❑ Private depth To Water Tab] ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date...................) No ❑ New Construction: Yes ❑ N /VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p c sewer is available within 200 fe t.� •��., oA Septi Tank: Distance from nearest well Distance from foundation--F................Material-- ..el. No. of compartments_-_Z------------------Size - __-Liquid depth-S'XI ...-_------.Capacity...rP .. ... t q Disposal Field: Distance from near t well...��--....Distance from of ation_- ?--------Distance to nearest lot line...... Number of lines-_--_7---------------------------Length of each line-----�--0---_----_--.Width of trench_4__V«--_.-------..I—e ..... Type of filter material.$ ---Depth of filter material__-_---1-,57�*._Total length-----------------f' D f See a e Pit: Distance to nearest well---- ---Distance from foundation/j.—V _.,Distance to nearest lot line_---- � Number of pits-----/---------------Lining material__- Size: Diamete - ---- Dept h.......Z-%F....... ....... Cesspool: Distance from nearest well,_............-Distance fromoundation--------------------Lining material.._---.----.--.___.._---._-.-.._._-- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well _.-------------------------------------- -------Distance from nearest building----__-_..--.---_-_.-_-_---_..__--------. ❑ Distance to nearest lot line---------------------------------------------- ------------------------•----------------------------------------------•-•-----------•-------- Remodeling and/or repairing (descri ----- -` - -- -- ------------------------ -------------------------------------------------------- y --------------------------------------------------•------------ `... ..lf - ri ---------------•-•------....---- ----------••--•-------•------------------------------------------------------------------------------------------------------------------------------------------------------------------.- --------------------------------------------------------------------------------------------•----•.....---------------------------.--------- .-..-...--------------•--......................-------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ;kws , and r es and regulations of the San Joaquin Local Health District. (Signe �- --- 3.!77171 --- -_- - , --- ------------- (Q�`wt��j(�Contractor) By:------------------------------------------------------------------------------- ------(rtie)----------------------------------------------.- ------------ (Plot plan, showing size of lot, location of system in relatio wells, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.......... ---4------ - --- ---L�--------------------------------------------- DATE-----=�--T f '� 4 -'---_---------- REVIEWED BY--------_----------------------_------------ ------- ---------------------------------------------------------------- DATE------------------------------------- --------------------- BUILDING PERMIT ISSUED-------------------------- ---------------..--. ---------- ............... DATE-----•------------------- Alterations and/or recommendations: ------ . _ �� ={ -r�. --_ f' --- -�' ---- j - -----? ...•-- - .........�-�/..., r?Y e...-----•/-------- —j(-_-�------------ -------------------------------- ......_....------------------------------------------- ------------------------------------------ -------------..-..--------------------------------------------...---------..............-------------------------------- FINAL INSPECTION BY:.--� -- ------ - ------ �� .-_- -� Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLAS