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FOR OFFICE �15E: E -�,--_-_,.._._•._. ______________________________ APPLICATION FOR SANITATION PERMIT Permit No. ...1.7:.7.. t (Complete in Duplicate) *2-, -----------------------------==--------------------- ---- 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 AND LOCATION---- �J�l: 2..._.- G= ' Owner's Name-- =_ , �';:.: -= . --- Phone...............•-------------------- Address. 1 ` 7`i--:....__cz��/L = ,...------Y------•-------------..------------••-------•- ............................................................-----• ....----------- R Contractor's Name.-_ ta..__` -.� •- Phone................................... Installation will serve: Residence M--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j____ Number of bedrooms __. _ Number of baths Lot size _1 Zk_)r ai2_�5__......_. ---------•-••--- Water Supply: Public system [A—Community system ❑ Private ❑ Depth TO Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M--Hardpan ❑ Previous Application Made: (If yes,date____________________) No Z—New Construction: Yes E� No ❑ FHA/VA: Yes ❑ No [9-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept',jTan Distance from nearest well-_-,-----------Distance from foundation--------------------Material---------------________-__._-----___----___-.--- No. of compartments-------------------------Size__'__`-- `---~----'-----------Liquid depth--------=-----------------Capacity---------------------- Dispo al Field: Distance from nearest well.-__-___'__=_ Distance from foundation-------'_----------Distance to nearest lot line-----_:.-___-__`_ i s g Number'of lines-----------------------------------Length of each line----------_------------------Width of trench-------------------------.--------- � u Type-of filter material--------------------- Depth of filter material--------f:__•--•-------Total length.............................................. Seepage Pit: Distance to nearest well_sn' --- _______Distan rom foundation___YA---------.Distance to nearest lot line... ........ ❑ Number of pits____.--._-:'I ___.__Lining matenal.j_Q_CX_-'.____.Size:�,Diameter___;_;:�.�:`'_.___.Depth__-.`..0 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---------------------------------------------_"..........................-•------------------------------------------------------------------- Remodeling and/or repairing (describe =-------------------------------------•--------------- ----------••----------------------------------•-------------•------------------------------ ---------------------------------•--•------••------•---------------------•------•-------•-•----------------------------------- 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 egulations of the San Joaquin Local Health District. (Signed) __.-_._Owner and/or:Conteactor BY: ---•----- [Title)_ ------ •-----------•------------------------------------------- -----------•.-------�------- (Plot 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---7 ------------------ REVIEWEDBY----------------------------------------- -----------------------------------•-------------_---------------------- DATE-----------•-----------•--•------------- .................. BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE.----------------------------------=------------------------- Alteratio s and/or rmendations:..- 3j----•- ------'-------'------'---f-' ( --Cm = _ ___________________________________________________________________________________________________________-------- _ _________________ -------------------------------------- _ __________________ f t ............._----------------_------------------------------------------_____------------------------------------------------------------------------------------------------------------------------------__________________ F __________________________________________________________________________ ....._------------------------------_---------------------------------------------------------------------------------------------------------- ___ 3 FINAL INSPECTION BY:. Date ..'-.._ .-."�. ------- ---------------------------- l 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 ` r