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1-UKUVI-ICt � �7, 7 / --------------------- ---_--.---..-...--_.-__-._______. APPLICATION FOR SANITATION PERMIT � Permit No. :.../(�- ------- ----------------------------------------- ----------------------------------------- --------------- (Complete in Duplicate) Date Issued --------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in complianco with CtyGOrcl inaryeNo. 519, f ,p � JOBADDRESS A D�LCATIO F?a --- -___-Owner's Name_-_-.- - - --•A:;--- - -- --------•----•------------------------------------------------••--------------------•-- Phone._ Address ,,, . ....�r . ------------- - -- -- ----- - --- ---- . Phon ... Contractor's Name------------------•-- . - ... - .............. --- - --- ------ -- - -----------------•---.......-----•- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ -- Number of bedrooms .�;?Z_. Number of aths '_.l_ Lot size __-- elJ... :..................................... Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table&P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam 2""bay E] Adobe❑ Hardpan C]Previous Application Made: (If yes,date--------------------) No gKINew Construction: Yes ❑ No g�'-'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) p nk: Distance from nearest well--. ...........Distance from foundation...:................Material................................................. No. of compartments-- Size--------------------------------Liquid de th..._-_-__-..-------.-----.Capacity 11 Distance from nearest well-1.5-Q--01-._.Distance from foundation-./49 _------Distance to"nearest lot line..;?.SV ®� Number of lines------- ---- --- Length of each line-------------�la- .Width of trench._.-.. H _-- Width of � _ .•.-._-_ Type of filter material._!- . Depth of filter material----._-4�-------Total length._............•_-__.5f4--___..._...` i Seepage Pit: Distance to nearest ell/0.6----------Distance m f undation__�_s_.......Distance to nearest lot line�.� [� Number of pits------ ------ -----Lining material-- _ - ----Size:'•Diameter-..__-?J_. � Depth_-...�2 .--•..-...... 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 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta aws, and�rui s and re tions of the San Joaquin Local Health Districf. (Signed) �_� _(jDwner and/or Contractor) By:----------••---•-- -•----------------------------------(Title).... ------------ -----_--------- (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY c� APPLICATION ACCEPTED BY '64.57 t t -'fir-. DATE----2 -� ......... .. _' _:_...-.. REVIEWEDBY------------------------------------------------------------------ ------------------------------------------•------- •------- DATE-------•----_--- - -------- ...... BUILDING PERMIT ISSUED-------------------------------------------------------------------------.......................... DATE. -! - Alterations and/or recommendations:..- ... -a- _ r-,{3 -e- __ _ -- - tQ� ------------------------ ........ 07.> - -------------•--------- -- -- - -------`--�-- . . ------------- /....,.,�.-.0 Com*-� � '-� � -.-- L 6/tel FINALINSPECTION BY---------------------------------------------•------ --•--------- Date----------- ----•------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wort Oak Street 124 Sycamore Strait 205 Wort 9th Street /# Stockton,California lodG California f Manteca,California Tracy,California E6 9 REVISED 8.59 2M 5-61 ATLAS �i