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FOR OFFICE USE: -------------------- ----------------------------______-------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..t�:� !. (Complete in Duplicate} (� -------------- -_. This Permit Expires ] 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. I JOB ADDRESS AND L TION--------A-- - / ' � 1 1 ��r �. •� Owner's Name... � �; / / Phone_...------------------------------ Address - (, ---�t - - !' -------------------------- Contractor's Name 1 �¢ ? 1� .-a �Z fr,.. ------------------------------- -----..... •------ Phone-------•----------•---------- ' Installation will serve: Residence [j,"A'-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ #' Nurr'lber of living units: __j____ Number of bedrooms ----'?,Number of baths T._- Lot size --------�'�_,�_..�rl�e_______________________ Water Supply: Public"system 24,,ocommunity system ❑ Private-❑ Depth to Water 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 Q----New Construction: Yes �o ❑ FHA/VA: Yes ❑ No [+�. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep+ie.T k: Distance from nearest well__ -----+�'.__..Distance from foundation__ l_e.�T.Material---�G.�_r/-C.�-....-.... { ,No. of compartments..-_____2—____..__.._Size__��"(�_,�l _..Liquid de F( Capacity.....1SS 'p..... Disposal Field: Distance from nearest well '� -._Distance from foundation.___14-:___.___-Distance to nearest lot line........... [� Number"of lines--, ___ �y� -_._ _Length of each line.# �_�t�?1___ �___.Width of trench ,r _ `�_______________ T e of-filter material._._�y_ __ss' 4 YP l� - ----CYiept�i'rof filter materlaL----,1_ --- -`_Total length._._�_�_-.-----•................ Seepag It: Distance to nearest well_____-`-----------Distance from foundation--/--------------- to nearest lot _-.- Ur Number of pits----2......_____Lining material___ Size: Diameter__-_ Depth--- .................. Cesspool: Distance,from nearest well-----------------Distance from foundation-------------------Lining material........______-__________-•----.---.- ❑ Size: Diameter------------------------------------..Depth--------------- ---+ -- ---;-f•__ _Liquid Capacity--------------.......-----.gals. Privy: Distance from nearest well-_.-.---_____________________-___________-_.-__Dist ance-from'nearest building------------------------------------ 11 Distance to nearest lot line--------------------------------------------------- �._.. ......... r Remodeling and/or reRairing.(describe)----------- --------------------- r /u` --------------------------- ----------------- r I hereby certify that I have prepared this application and that the work will die done irl accordance with San Joaquin County ordinances, State la , nd rule a regulations of the San Joaquin Local Health District` -r.•(Sigfted)-------------- � .---:=••--- -.- •d � ---- �-.----------.-----•-•-•--••-----------------------------{-----,-'---- Jiy�•�1PndContractor) i r , C. By: 2 l -�- ----- --- --- --------------- --- Title----- (Plot plan, showing size of lot, location ofJsysfei in"relation to-wells,-buildins;etc:,can kie"'placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - DATE..-_',Z- ------ .r- ------------------ REVIEWED BY------------------------ ------•---•••-•-----•- DATE................._.. BUILDINGPERMIT ISSUED---------------------------------------------------------------............-------------------------- DATE---------------------------------------•--------------••---- Alterations and/or recommendations:__________t_______ ___________ ______________ ............... ....-•-- ......a` �! __--.. ..._. .1- �... ._----�s---�------------------...... -- .+"�-'�. '"-��=��f� Y4r.__JC/�riC�_-:.�F.3.G - Ger_ _ A -`r _-- _..:- ----------------------------- -------- -FINAL IN PECTION BY: -----------------?- y '---------- 1 { Date_----------------------- -----• -------------------------------------------- SAN JOAQUIN,.10 --------------------•---------------------- SAN+JOAQUIN,.10 AL{HEALTH DISTRICT 130 South American Street 300 West Oak Street' 114 Sycomore�Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 6-61 ATLAS