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FOR OFFICE USE: ------------------------------------- ---------_--------- ------- -- -----._.__-_-- ---------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .................. ----------------- -------------- ------------ ------ (Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued Date Issued ..__.__>!__'. -3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de crbed. This application is.made in compliance with County Ordinance No. 549. p Z•S_ rD0 --Db ,?4 D!o w- �Tr '�-°U A-" f} c JOB ADDRESS A LOCATION- Z_.1r�, .,�._r __F/rs, .. __.tZ-r.-•,,RQ_______ u�- .__S�La Owner's Name - ------ --- --�._ ------------------- Phone---------- ....... -- - ------- -- Address. 2.• ---- ` r to Contractor's Name--------- =:-.... -------------- ------- Phone----------•----------•----•---••--- on will Apartment House InstallaNumber of living Runits:nCe___ Number of bedrooms��mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ • g Number f baths __l.__ Lot size _.__.__ + -r,-� :�.............. Water Supply: Public system ❑ Community system ❑ Private 7Depth.T ater Table -------- 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 ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ / r Septic ank: Distance from nearest weal____, a_..__Distance from foundation___-1.6__.______.Material_._..Q.,�' s �a.eG.e�(�.__________- tz+ y e r r , No. of compartments-----------•----__........Size_�.X-_1.0___3(_$___Liquid depth---,�------------------Capacity.--- --4L� TTDispos Field: Distance from nearest well..-.SA Distance from foundation____-/�l__ ......Distance to nearest too inetS___.___..... Number of lines--------- ----- -____.l_____---_ Length of each line_._J.b10__ ____________Width of french___�__._..----_.-__________-__ Type of filter material._._&___Depth of filter material__�_A-_.--_______Total length----14t _.'_______________________ 17 Q Seepage Pit: Distance to nearest well----------------------Distance from foundation--------.___.-------Distance to nearest lot line____.___.________ ❑ Number of pits-----------------_Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 171 Size- Qlameter-------------------------------- ---Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------- _ -----Distance from nearest building _________- ❑ Distance to nearest lot line----------------------------------------------------------------.------ Remodelingand/or repairing (describe)--------------------------------------- ---------------------------------------------•------------------------ .............------••--•---•-..--•--- •--------------------------•- ----------------------------•---------------------------------------------------------------------------------------------------------------------------••---------------------------- ..---------•-----------------•------------------•------------- -----------------------------------------------------------•-----..._...------••--••---------------•---------••----•-•-•-----. ---..---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I , and rules and reg anon of th n Joaquin Local Health District. c r' (Signed)..-.._.. �} -------------- ---------------------------------- nee and/or Contractor] ----------------------------------- BY:---------- - --------- r----- Title ------- .......... (Plot plan, showing size of lot, ocation of system in re anon to wag-buildings. etc., can be placed on reverse side), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ --- - --- --- - -------------------------------------••----------------------. DATE-- -- -'C3 •-•------------------- REVIEWEDBY---------------------•-------•-------------- --••----_----------------.... DATE---------------- ------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------- --_----------------------------- .............-------------- DATE------------------------------------------------------------- Alterations and/or recommend'ations------------------------------- ---------------- ------------------------------------------------------------------------------------------------------------ -1-----------------------------------------------------------------------------------------------I------ ----------------•-------•-----••---------------------------•---•-----------•-------------------•---------•-----------------------------------•---------- ---------------------------•---------••--------------•----------------•-------------------•----•-•--------------- FINAL INSPECTION BY:. ------•--•---------------- Date---- .Z." - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strut 134 Sycamore Street 205 West 9th Street Stockton,California lode,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLAS