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FOR OFFI E USEy --------------=�:____---.----.--. APPLICATION FOR SANITATION PERMIT Permit No. ---------- ------ (Complete in Duplicate) J / Date Issued -------- ---- This Permit Ex ires 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 herein described. This application is made in compliance with County Ordinance 44. JOB ADDRESS AND CATION. _ 1-7 --------------------------------------------...................•--------------------------- Owner's Name....... - -" COd ---- ---•-----------• --•---------------------------------------------------- -- Phone.................................... Address-----------•� f�._, �_.�` Contractor's Name. - ---------------------------------------------------------------- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ /Trailer 6AMW Motel ❑ Other0 le ❑ Number of livingunits: --!-. Number of bedrooms -vie. �/ �r. Number of baths __�-- Lot size ��,/.�.-ZA,.17_____________________________ Water Supply: Public system ❑ Community system ❑ Private [V Depth To Water Table _ tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ 01ay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No•❑ FHA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available.within 200 feet.) h Septic Tank: Distance from nearest -_-Distance m foundation---" -_-----. ....................... ®� No. of compartments-----,Z---.._-_---`--Size -_ -_x- � -_._._Liquid depth !� __._--.---._Capacity--e� Disposal Field: Distance from nearest well--- -.p-----Distance from foundatio --- ...Distance to nearest lot line.. ........ � f ®� Number of lines-------/----._- Length of each line.._-- -_f. -----------------Width of trench--,A`.../------------------------ Type of filter material/,) 4e th of filter material--- P ��----------Total length-----?Q...-------•------------------ Seepage Pit: Distance to nearest _ well__,/_-__.Distance foudation.....�....,.,..Distop..-a to nearest lot lin;---4 _ ... Number of pits----- - ----------Lining materia -Size: Di ' -_-. -_-_--.__---_-_----- - Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material---------------.----..----_--__.-.--. ❑ Sile; Diameter--------------------------- ----------Depth----------------------- ----- ----------------------Liquid Capacity---------------------------gals. Privy: D.istrce from�nea`rest well------------------------------------------- --- .-Distance from nearest building--------------------- . �,❑ Distance to nearest lot line-------------=--------------------------- `---------- -....... T .. Remodeling, nd/or repairing (describe)----------- - , -••-- ------------------•---- ------ -•- •------------------ ------------------.--- ---------------- ---------- -- -------------- -------------------------------------------------------------------------------------------•-.-___.-___-..___----..--_--------_----_------ r- . I 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 ules end regula+io of the San Joaquin Local Health District. 1 (Signed) ---- ------- -------- r Contractor] By:-------•-----------------------------------'.... r ° /I.d/L------- --- - -------------- (Plot plan, showing size of lot, location of system in r iont"tii wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY=:- ---- -= _ --------g---------- -------------- REVIEWED ••----------REVIEWED BY -��---------------------------------------------------}---•--- ----------------------------- DATE--------•---................•-• BUILDING PERMIT 155UED-:`..... `- -------------------------------~ �---€---------`--.-..------------------- DATE----------------------- Alfkrafions and/or recommenefations:.--- %_` + . '� -- -------•----------•-------------- ----•-- ..........................------------------------- --------------------••-•-- •-------••------•----- ` ---------------------------------------------------------- ---•------•----------------------------------------------- ------------•------•-- ' � . ' Q FINAL INSPECTION BY:.... .,1------. Date ------------------------- 4\ • - `SAN: O 'QUIN.LoCAl:,;HEALTH�DISTMCT ! �. t�.. 130 South American Stmt! 300 West Oak Street 124 Sycamore,Street 205 Woo 9th Street Stockton,California Lodi11 ,California Manteca,California Tracy,'California r 5 9 REVISED 8-59 2M 5-62 ATLAS r