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FOR OFFICE SE G _ '34, i. ..___`_--- .__........................... APPLICATION FOR SANITATION PERMIT Permit No. ._�_.X�l�l........ --------------------------------------------------------- (Complete in Duplicate) �f --- This Permit Expires 1 Year From Date Issued Date Issued ......1..��_ z Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work herein described. This application is made in compliance with Coun Ordin Nof54 . /33 JOB ADDRESS AMD LO T10N__Ip _ 3 ---•--•- Owner's Name -- - --- (y --._..__..._ Phone.. t -------•-• �- ---------------------------------------------------•---•--•-----...-•----••--•-----••-------•--•----....._.•---- • ........ Address --------------- Phone................................. Contractor's Name-- � • • --- -- Installation will serve: Residence ❑ Apartment House-❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ,�.._ Number of bedroomvd.. Number of baths`(.--• Lot size -_-_ ................................. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 6.Tj--- ft. Character of soil to a depth of 3 feef: 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.) Sept' Tank: Distance from nearest well-----------------Distance from foundation....................Material--------------------------------....... No. of compartments--------------------------Size.................... .......:__.Liquid depth--------------------------Capacity....................... Disp al F' J Distance from nearest well --- e_____Distance from foundation._l0._ -------Distance to nearest lot line J r A � Number of lines--------------- --_-. Length of each line--------- of +ranch----t7�__�f__------.--.------------ Type of filter material------ Depth of filter material_=._1?y...._..._Total length--------- !9D........~'_______________ i Seepage It: Distance to nearest well----- '---_-______Distance fo ndation=:.1.___.'.._-_.Dist rhe to nearest lot line-2�l�-___-• Number of pits------------- --------Lining material-__-�---Size: Diameter-----3-�--------Depth-------z .`.._....-________ i Cesspool: Distance from nearest well-----------------Distance from foundation--- .''-_.-._--_.Lining material...............--_-.: ❑ Size: Diameter-------------------------- • . ....._Depth----•------------------y---------------------------Liqu;d Capacity--.---------••--- -•-•--..gals. Privy: Dis+ante from nearest well-------------------------------------------------Distance from nearest building. ...................................... ❑ Distance to nearest lot line---------------------------------------------- Y iRemodeling and/or repairing (describe):------------------------------------------------------------------.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 rule4ioof tion of the San Joaquin Local Health District. (Signed) -....__. --- --------------- ---- -------------------------•-•------------------------•---... •...(Owner and/or Contractor) 9 •-------•--------------- By:-----_-----••--------------- ------- ---- -----------------------------.--------------------------------------(riifle)----------------------------------............._.---- ---- (Plot plan, showing size. of to , otem in relation to wells, buildings, etc., can be placed on reverse tide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--.,-)— = - ----------------------••--------------- DATE---_3--�-1__C r REVIEWED BY------------------------------------- •------------------------- DATE------------------ BUILDINGPERMIT ISSUED__....---------------------------------------------------------------------------------------_ DATE--------------------------------------------------------:--- �Al%rafions and/or recommendations:-------------------------------- ------ --- ------- ------------------ .... -------- ------------ ------- / = t ----------_-- .....------� -------------- ----------------------------- ............................................... -------• ------- ------------------------------------------------------- I ------ ------------------------------------------- ----------------------------- ------- -------------•-- ----------------------------------------------------------------------------- -- FINAL INSPECTION BY: Date y ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 3 E8 9 REVISED B-59 8M 5-61 ATLAS a 1�,