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FOR OFF1 USE: . --------- -- -------- - 3/ --- --- -- APPLICATION FOR SANITATION PERMIT Permit No. __ �......... --------------------- ------------------------------------ (Complete in Duplicate) t -----------------_..-_.___ ---------------- This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS A LOCATION-- -7�----lf- = ............................. Owner's Name------- ------fA! ------------------ --- ------ Phone...........---------------------- Address............ --------------------.Address......_._.._ ' Contractor's Name--.---- ham* / -----------------------------------------------------------.................... Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms A. Number of baths /--- Lot size ,;�X_Xl.��...-........................ Water Supply: Public system [Community system ❑ Private ❑ Depth ro Wafier Table _# 1 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 2-14o ❑ FHA/VA: Yes [9� 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 w L---_ _..Dista ,,frr��rom foundation--- ®---------Mater�j/�r. t----- '� __...... No. of compartments_.- ----------------Size __!e /0______:__-Liquid depth____ _ --------Capacity.. -•-___ Disposal Field: Distance from near f well._-J""_.___.-Distance from founda i n---! --------Distance to nearest lot line_457.._...... Number of lines... _--_-_�_j_ ____..__ Length of each line_ ______________________Width of trench._A-___---�-__________--___.__ R Type of filter material- Depth of filter material..../�___-.....Total length.....�rO'�9_______________________ I J. Seepage Pit: Distance to nearest well_______________-------Distance fr m fou dation___.___©.___....Q'st ��ce to nearest lot,f{me__ __-_ Number of pits--.A--------------Lining material-/_ 8 8 &,Z .Size: Diameter-24.... � +a?--.-.................. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material...___.-_--------,_.____--__---.--_-_ ❑ Size: Diameter------------------------ -----.Depth----------------------------------------------------Liquid Capacity.... -----------------------gals- Privy: Distance from nearest well______________--_.______-_._---___._--.__--_--.-Distance from nearest building____--____-------..........._____-_._. ❑ Distance to nearest lot line �------------------------------- -------------------------------------------------------------------------------------------.-1---------------- 4 Remodeling and/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 rules and �regulations of the San Joaquin Local Health District. c__P (Signed)_ `- - tlCl Contractor) d Title By------------------------------------------------------------- - ------ -- -----------( � 1 = (Plot plan, showing size of lot, location of sy min relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -- - - -------------------------------------------M--------- DATE------- - - --- -..._ 1---------------------------------------------------- REVIEWEDBY-------------------------------------------- ----- ---- ---------------------------- ---------------------------- DATE. BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE------------------------ r------------------------------- �� l Alterations and/or recommeridrtions:---}�---2.3-- �'�-----------�----- }-�-�- �-�-----••------- --------------------------- t- , 11"cam-` -' �'`� . - './rn---------------------------------------.......................... ..-.-.1 - -�-��31d-- ---- -----` .P ---- - FINAL INSPECTION BY:.. . -------- Date_._ 7 4� /" 5 :-- -G- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantua,California Tracy,California ES 9 REVISED 8-59 ZM 5-42 ATLAS