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FOR OFFICE USE: ---------------------- Permit No. -- ...,1 .l.l._� - ------------------ APPLICATION FOR SANITATION PERMIT -------------------------------------- {!Complete in Duplicate) ti Date Issued ---- �_ This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap lication is made;in compliant-e.with County Ordinance No. 549. JOB ADDRESS AND`LOCATION "" .�Lt! °'�- 1F --r -- ----• !`�" Name----- ..... ! 5 f.----- --__- _ Phone------------------------------ Owner's •----- Address r� r---------------••- = <. /rr!,.2_ ... -•--•_-•---- Phone---------......................... Contractor's Nam 9 ----------•--- T/ Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Traile�r -C,ouMotel ❑ Other ❑ ri Number of living units: _t..___ Number of bedrooms _3_,_ Number of baths �'___ Lot size -_-oe - Water Supply: Public system ❑ Community system ❑ Private §0 Depth,To Water Table %3-0- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe❑ Hardpan 01 Previous Application Made: (If yes,date-------------------) No j New Construction: Yes J2 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_ _-____._Distance from foundation___.lQ'___..__.Malt`erial___ •-•--•-•- --•---� '1 Iq{ No. of compartments----_-_--_- . Sizea _=' '._7'_�= _Liquid depth 7'-r_- ._Capacity. o-d ..__. pQ Disposal Field: Distance from Weare wello ��.......Distance from foundation__/a.----.----•Distance to nearest lot line._S.......... ,,rr�� , t rete Number of lines____:.-.------ _--------------Length of each line.?�iC -Width of }ranch__ _ x_____----------_-----. LU i. Type of filter materiae- er/Depth of filter material -----------Total length-___,ei`- - -----•-----•-----•• Seepage Pit: Distance to nearest well--- --n --Dateaace from foundati nDiameter----J-------------Distance to nearest lot line----------------- Seepage .-...-_•---: � ❑ Number of pits Lin g Cesspool: Distance from nearest well__7__'---------Distance from foundation--------------------Lining material__-_-_-______-_-_________ - 1S 5. ❑ Size: Diameter-------------------------------------Depth-----------•----•------ fT!- -- --- -------- ------------ Capacity----------------------- ...9 ' Distance from nearest well----------------------------------- _'-Distance from nearest building-------------------------------•---- Privy: ❑ -------------••----_.-------•---------;-.• ---------------------------------- -------------------- r Distance to nearest lot line------------------------------------- ---------•------------ I _ --- - -------------------------------------- Remodeling and/or repairing (describe):-----------i----------------- ••- _- --- ' ----•-_ .------•----•--------------------------------------------------------------- -------------------------------------------------------------------•---•--------- •----•--------------------------------- hat --------••-----•---- ----��-- ave prepared this application and that the work will be done.in accordance with San Joaquin County I hereby certify that I h p p pp ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed - --- - - - (Owner and/or Contractor) t _ -------ATi+le By-------- ------ -- (PIo+ plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY- DATE_._ --- I REVIEWED BY------------------------------------- --------- ---------------------------------- -----------••-----------•-- --------- DATE-----------•----- -------•-------------- -------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------•------------- - •------- DATE--------------------- Atterafions and/or recommendrations--------------------------- ------------------------------------'--------__- ,[ FINAL INSPECTION --------- --------- Date---"v�77_4- 7413 -----•----------- ----------------. BY:- _-_-- - _-�:yg��^ � ;� - - 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 ES 9 REVISED 8-59 2M 5-62 ATLAS -