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r FOR OFFICE U APPLICATION FOR SANITATION PERMIT Permit No. .;�.. -• 6�-j.-- - d ------------------------- z/ - ---- . (Complete in Duplicate) Date Issued .. a .--_... .- '- This Permit Ex ires.l Year From Date Issued t- i Application is'hereby made to the San Joaquin Local Health District ��rcnito runs and install the work herein described. This application'is made in compliance with County Ord' ev,cW 9 �. JOB ADDRESS AND LO AT[ N = .-1s1�_________________ ____ f � -----------=— A Phone.... Owner's Name = Address_._..... ;ao:: --------------- --------------- ..---- Phone................_---------••---- ------------- --- Contractor's Name. - __ _ -------------------------- -- Installation will serve: Residence 00"•Apartment House El Commercial ❑ Trailer Court ❑ Mosel [3 Other ❑ Of Number of living units: __Z_" Number of bedrooms ✓" " Number of,baths .1.."" Lot size ZW x-4?7------------------------•-••- Water Supply: Public system ElCommunity systemivate El Depth to Water Table I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe El"'Hardpan ❑ tl' FHA/VA: Yes (a'No ❑ Previous Application Made: (if yes,date-------------------- No [ New Construction: Yes [ to ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public-sewer is available within 200 feet.) Sp tic Tank: Distance from nearest well_--------._-----Distance from foundation_" _ - Material_" � ...._.... p --- �y..Li uid de th �/ Capacity... ..��---.... i No. of compartments"."- - Size ✓�- q . R p ' Disposal Field: Distance from m nearest well---.^�'---.Distance from foundation.._If_`....-_-Distance to nearest lot lin ........... ©� Number of lines""_.... 7--"-",---. Length of each line .r2... Width of tranch" _---- ---------------- !f Total length----. -------------------- Type of filter material.-Z/- epth of filter materia{"�- D "t� ___"_- "-. 1 - is 10 Seepage Pit: Distance to nearest well_--_`�''-"-_ Distance f _•/'m fo dation.../PDist rete to nearest lot line-4 Number of pits-"""�c------------Lining material.._ . :Size. Diameter.- .-------------Dept h_.141"J.___"----------------- Cesspool: bistance from nearest wall."_""""".__""".._Distance from foundation--------------------Lining material..--.-----_-----_---__-_..__."__"..._ Li uid Ca aci .gels. ❑ Size: Diameter.-------•-----------=--•---- -----..Depth------------- ------------•-�---------------------,., q p tY...----......------••-----• , Privy: Distance from nearest well------------------------------------------------- from nearest building---_.._-----..._"""_.....----_�------- � ❑ Distance to nearestdot line------------------------------- "" = ----r--- - ----- f{ "_-•-- Remodeling and/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 laws, and rules'and regulations of the San Joaquin Local Health District. - -- --------------------------------------(CWX6FTtWor Contractor) (Signed)•-------------- . • - --------------- - - •-------- By:....................... ...---------(rtle}"".. 1 � ---------- --------------- (Plot plan, showing size of lot, location of system in relat' to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY7 �._-- -___-- ------- ATE_ --------------------------- - - x__�z-- --------------------------- REVIEWED BY----------------------•-----------------• - DATE------...._....--------------------------------------------- ----- --- ------ BUILDING PERMIT ISSUED---------- -------- -------- DATE _...------------------------------------- Alterations red/or recommendations.-•- ------ -." _ _. _ .--- --- .. �_ ----------------"_. ---- h- .�....,"""��" ----.---.-- . --------------------•- -------------------- -------------------------.------ FINAL INSPECTION BY:..-- -- Date i SAN J AQUIN L CAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California 3 ' ES 9 REVISED S-59 2M 5-61 ATLAS �4