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FOR OFFICE USE: ----------------- .... ...... ------------------ ------ ------------ --------- APPLICATION. FOR SANITATION PERMIT Permit No. .....-- ----------- ------ -------------------------------------- (Complete in Duplicate) -Date Issued ....... ------------------ - ----------------- -------------------- This Permit Expires' 1 Year From Date Issued Application is hor66y r�nacle 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. JOB ADDRESS AND LOCATION-----------------I-------- ----- --------C5 Owner's Name.._................................... ........... .. ------------------------ -------- --------- Phone;r-,p--- -------------------- Address--------I............................. ........fi-v---------? =........ .............................. � I- . k. m Contractor's' Name--.-- ......................... •--•-----------I............... Phone..........................-------- m Installation will serve:-,Residence 52`�Apartment House El Commercial -[]._Trailer.,Court, [], Motel El -Other [3 Number of living units:' ____'Number of bedrooms_'-3 Number of baths Lot size ---------------------------------------- Wafer rSUPPIy: Public.system ystem [I Community system 0 Private �epth-to Water Table/ACft. Character of soil to a depth of 3 feet: - Sand [3 Gravel 0 Sandy Loam E] Clay Loam E3"Clay E], -Adobe[] Hardpan ❑ Previous Application Ma.do: (Ifyes,clate--------------------) No�New Construction: Yes ga,'No [] FHA/VA: Yes [:] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:- Distance from nearest well--x- --Distance from foundation____.. -------Material------ -------------------- No. 6f com-partments--- -- -------------size......7.. 47 f K?,-Liquid depth---------41-------------- Disposal Field: Distance from 'a. ne rest well ---- ---Distance from foundation-- - ..-..Distance to nearest lot line___.-f......... Number-r of lines--------t---------- Length of each Width of trench....,A-.-.q,- ---- -- - --------- - - - EV -------- Ty�-4- e,6f',filter materia'I.-Ze- Depth of filter'mate",ial 2_'ao---------Total length........ ----------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line................. ❑ Number of pits----------------------Lining material------------------------�Size: Diameter-------------------------Depth................................. Cesspool. Distance Distane from-nearest v;eII-----------------Distance from founclation'_-----------------Lining material_.._......_..____._.__ ❑ aterial.....................-El i, -Size: Diameter-------------------------------------Depth-------•--------••--- ----•-----------------------MLiquid Capacity------ I s. Privy: Distance frA 1k:nearest well-------------I--------------I-------------------Distance from nearest building____________________________________-__-- - ❑ 'Distanceito nearest lot line-------------------------------------------------- ---------------- ---------------------------------------------------------------------- Remodeling and/or re"�i..... (ces;ribe):----------�-r--_-------------------- -,--------------- -------------------------------- ----------. ..... .. ----- ---- .............. Q � ----C , 1% - t ----------- ..... --------------- ................... . ............... . -------------............. .......... .......------------ ----------------------------------------- -------------------------------------------------------I------------------------------*-------------------- --------------------------------------------------------------------------------------- ------------------ I hereby certify that I have prepared fhis*.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. -------------- -- --------------------- (Owner and/or Contractor)------------------------------------------------------- ----- (Signed)--�,04V_V,_ ri By:.. ------------------------------------------ ------------------1.------------------------------------------------------- ......... ------- (plot plan, showing size✓of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). D FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------—----------------- --------------------------------------- DATE--kffl -- ----------- C REVIEWEDBY------------------------------------------------------------------------------------------------------..................... DATE---------------- --------------.......................... BUILDINGPERMIT ISSUED-----------------------------------------------------------------••--------------------------------- DATE--------------------------------------_-------------------- Alterations;n ------ ig ;�- 7. an /,or recommendations:......... — ----- . ........ ---------------e----------- ................: -- --------------------- ------- ---------- ------ -------- ------ ..........I.......... _Z7-------........ .......................- ,-- ---- ------ ----....---•--•------ ------------ - ......I------------------------- -� . ....7"�..;'____' -------- --------------- .... .......... ----------- ---- Y FINAL INSPECTION B -ci�r------- -----------__ Date------- -- ------------------ ------------- SAN JOA LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISCO 8-59 9M 5-61 ATLAS