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FOR OFFICE S S 6 ,� --------- i� t ' APPLICAtTION FOR SANITATION PERMIT Permit No. .. .. ..... ------ ----------------- - - - � (Complete in Duplicate) Date Issued -------------------------! �. . ._ __ .i`. This Permit Expires I Year From Date Issued 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. - � ` e e & = -- `eco- u u -- ---------•---- JOB ADDRESS AND tOCATION: r�I � % -` "/ . -- - --- . Phone.................................. Owner's Name_ ....... ---------------------- ----- -------•------------------------ - ! �Address - i� t ..Contractors Name-------------------------------------- - ------ - --- ----- ---- -_X .... ..... ----------------•--- Phone----. ' Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court D1-Motel ❑ Other ❑ Number of living units: __, Number of bedrooms -------- Number of baths .....'__.Lot size-,______---------„......._____...................----------- Water Supply: Public system ❑ Community system ❑ Private [B Depth To Water Table -_....... ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ❑ Clay Loam ❑ Cl ay_❑- .Adobe�Hc dpan C1 Previous Application Made: (if yes,date--__.--------r------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA:fYes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic wank: Distance from nearest well____.? __.._Distance from foundation...1a--------.-.Material__:: ---- ��____ -_ ____________ x No. of compartments--- .__-_3-----_- -____Size 1 Z0_f�`.S�Llquld d � f epth----- __._ ---.----.-Capacity.24-�_;7_ ; Disposal. Field: . Distance from nearest Distance from foundation----f 6._,--_---.Distance to nearest loot line...-G......... . [� Number of lines---------�__.--=-----------------Length of each line...._..1_ - -.`---___--.Width of trench------------f_..._-.---_.----•-- Type of filter Depth of filter material------/._Ff----.-.--Total length---------2__4!�fJ-------------------- Seepa it: Distance to nearest well_.____ a:___..Distance from foundation---/__Q._____....Distance to nearest lot line..__-------- ` �l Number of pits------,Z-----------Lining material__, ....Size: Diameter.......4j-&9-1.._._.Depth---- ------------- Cesspool: Distance from nearest well._._-_ ....._`:,Distance from foundation-----------------_.Lining material------------------------------------- I ❑ Size: Diameter--------------------------------------Depth---------------------- -----------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well-----------_`•,----_----_------------------------Distance from nearest building-------------------....................... ! ❑ Distanceto nearest lot line----------- -\`------------------------- -----------------•--------------------------------------------•------•----------------------------- 11 (10 } Remodeling and/or repairing (describe):-------`�----------_------------------ ------------------------------------------------------••------•-•--------------------------••---•--------•--•-•- ______________________________________________________________________________________________________________________________________ ______________________.____________._-__--------_...--_---_----_.-_-_-_----_ ---------------------............------------------------------------------------------------------V__-_--_--_----__--_-_-_____----___-__--___-_-.-_-_____-__.--__---_----_----------------------..--_-_-..._-__--__----..--._ J � I ------------------------------------------------------------_-----------------------------------------_---------------------------------------------------___----------------------------------------------------------_______ �( I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County , ordinances, Statejaws. and rules and regulations of the San Joaquin Local Health District. OP (Signed) ------ �,/`'. -------- ------- _ = - ------�/��`-`-F' - -------------- = T(Cw a wand/or Contractor) yPT`f - '` LI L� I fit �'3 -------------------(Title)---------i------------------------------------. ------- BY:---`---:-- (Plot plan, showing-size of lot, location of system in relation to bells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.!_. ____ __ ___ r__________________ 4_�' ---- DATE REVIEWEDBY--------------------------------------------- --------------------------------- ---------------------------------------------- DATE----------------•------------------------------------------- . BUILDING PERMIT ISSUED------------------------------------------ •--------------- ------------.----- DATE------ ------ t , i Alterations and/or reco rnendations:...-- -. -- ---- - 4 `�-s r= 4=------ .. III ------- - - . llfr��-�=F�.--/t.0=`- r :. -------------------------------------------- -----------------------=--------------- --------- ------------------ - -- -------------------------------------------•--------•-------------- s / � -= FINAL INSPECTION BY:.-- ......`�~----------- � 1 Date---------- .�..:•-- /---- ------------------------- SAN JOAQUIN LOCAL HEALTH 619TRICT 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 6-59 2M 5-62 ATLAS -��