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- — FOR OFFICE USE: :7�_______��'P;_j APPLICATION FOR SANITATION PERMIT Permit No. _5 ----Z.._° ---=-- --------------------------------- ----I--- (Complete in Duplicate) o� 'I This Permit Expires 1 Year From Date Issued Date Issued ---- t. A4� 152-1sQ-o Application Is hereby made to the San Joaquin Local Health District for a permit to construct and install th work herein described. This application is.made in eb mpfiance with County Ordinance No. 549. laf'r are h 14+ 60, d (,(,1 F „,,,t . JOB ADDRESS AN LOCATION......_ Owner's Name nC� � Phone--------------------------------- .✓� AddressC.. _ �1_ .------•---------------------------------------- ----------•-.....---- Contractor's Name L� p' ----••----•----------•...............••---------------•------- Phone................................... Installation will serve: Residence W/O'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____ Number of bedrooms 2.-'_-. Number of baths _/____ Lot size ........ri_ t-.g Water Supply: Public system F&r Community system ❑ Private ❑ Depth ro Water TableS7 ft. Character of soil to a deptir1of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [j-Xclobe❑ Hardpan ❑ Previous Application Made:j1(if yes,date-----------_--------) No 5],-'-New Construction- Yes [ ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATIONAND SPECIFICATIONS: C_(No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1I' Septic Tank: Distancefrom nearest well " 7--Distance from foundation---/'?_0------- Material____-d l^t- •.•- No. of cfompartments----_2.......------size----- G.._ - .--Q_Liquid depth_______ -_-Capacity--- . -la-!U ' from nearest well__��_.-_Distance from fou ation__/,0-_....Distance to nearest lot line. /..... Disposal geld: Distance- T e of of lines_____________ _________.__.Length of each lirs �Sr______.Width of trench__c: Number?' t yp rfiiter material._.. - { -rDepth of filter material__1_�__%_--_"__-.Total length__.,,4"'&____________ __ ____ Seepage it: Distance to nearest well_____ ~---------Distance from foundation___-4+_�------Distance to nearest lot line_-, ...... [,� Number'iof pits___.__...-"_-Lining mate ria l___�-��_�..Size: Diameter--_S�"-"_"-".-.Depth-----��•.�______----________ Cesspool: Distance lfrom nearest well_________________Distance from foundation--------------------Lining material-------------------------------- ❑ Size: Diameter--------------------------------------Depth-----------------------•----------------------------Liquid Capacity------------ .._._.. gals. Privy: Distance-from nearest well-------------------------------------------------Distance from nearest building-----------.____-_-_-..-.-___._-__________. Dlstancei to nearest lot line ------------------------- Remodeling and/or repairing (describe):--------------------- ---- C �p ---••----5--- --•-••-----------------•-- i - ------------------••---------------------------,- �--�- ---- •---------------- ------------------------------------------------------------------ ------ ( �� I hereby certify that I Have prepared this application and that the work will be done in accordance with San Joaquin County l/" F ordinances, State s, and rules a gula+ions of the San Joaquin Local Health District. (Signed)------------- i� ;I� `!T wne ) ---- ---------- ---•-------------------f.� -(O r tract _. _ r and o on or By:------------------- (Title)j!� +: t�= ----- {.�(-�4 - - ------- ---------- (Plot plan, showing size of lot, oc ton of s+em in relation to wells, b , can be placed on reverse side), FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY__C�.-__x_n1z -------------------------------------------- --------------------- DATE____/ � _- c-_______ REVIEWEDBY----_------------------ --------------------_-------------------------- -------------------- DATE------------------ -- ---•--------- BUILDING PERMIT ISSUED--------------------------------------------------------------- ------ DATE----------------- Alterations and/or rec�lmmentions:- /... da = �.`..�------- 1- - - ------------- -- - FINAL INSPECTION BY:.(,i --------------------------------- Date... ...-_......-------------------------------------- SAN -------------------=- ------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California J E5 9 REVISED B-59 2M 5-62 ATLAS {