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FOR OFFICE USE: //7 S .________________.___.___..____.__--..___..________. APPLICATION FOR SANITATION PERMIT Permit No. ...� l ,~ ----- - (Complete in Dupllca+e) (Q ----------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued .4-.0 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 ip. 549. JOB ADDRESS AN LOCATION------ �lI`� IIT- C - -------------------------- Owner's Name__..__----- " --------- Address--------..... Contractors Name---- 1 �` . _ .�. ""'.'"P"'�----�---------T'r�_--_---------••------•---------•----- Phone................................... Installation will serve: Redence E�Aparfinent House E] Commercial Trailer Court ❑ Motel ❑ Other [-1Number of living units: - .. Number of bedrooms_-�_. Number of baths Lot size ......73_X-------.1- 7................ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth'To Water Table .Y._ ft. Character of soil to a depth of 3 feet: Sand d Gravel ❑ Sandy Loam ❑ I,Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No Z' New Construction: Yes Rr'No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 20 O,feef:.) Septic Tank: Distance from nearest well-----------------Distance from foundafio�n.�_______\._Material________________________________________________. 7DNo--of�com ar is-1_: _ ____. -------------------------------- gp �'" I th Capacity Disposal Field: Distance from nearest well__.5 ._._Distance from foundation/U__r_?n*_.DiD nce�tonearest lot line___-��.. izeLI uid de �� g � __._.Width of french.--—:3� �- IFXj`{7 L Number of Ines______________ _-_ --- _ _Total le tri____ "�_.-__ y ti �� Type of filter material._: __G��",�-___Depth of filter materlal___��_.�_��___ �lg ......... ..:... T'"'�"+.._.. ___.___Lent o each line- ______� Seepage Pit: Distance to nearest well________________ Distance from foundation.1 to nearest lot line__.________.___-- ❑ Number of pits----------------------Lining material=----------------Size: Diameter---------------T ____Depth---------------•----------------- �1 �- .� Cesspool: Distance from nearest well-----------------Distance from f da#.ion_ ----------- ----.Lining,rraaferial____.___-_--___._ --......__.________ ❑ Size: Diameter--------------------------------------Depth----------------------------- ------- --1._._Liquid�Capecity--------------------........gals. Privy: Distance from nearest well------_--------------------------------------tDistance ro.mear'estmbuilding_ __..._____-_-_--..- ❑ Distance to nearest lotline °�_..------------------------------------- -------------------------------------------------•-------- ------ {�I Remodelin and/or re airin (describe):____ !! g / PDP__rL _ -------------------- ��- -It tail Df r± -----------------I--------------------------------------- ------------.-•------------------------------------------•- ------------------------------------------ ------------------------------ --------------•---------- �=�� ------------------------------------- I hereby certify that I have prepared this application and fha+r+}►e work will be done in accordance w+h San Joaquin County ordinanc Cafe laws, and rules and regulations of the Sar( Joaquin Local Health District. Sine ..� `------ -- ----------- -------•--•--------------• - �-------{ ) g ----- y (OM and/or Contractor By:_ = ------------------------- ={rale) - - (Plot plan, showing size of lot, location of system in relation f14wells, buildings, etc:,`canTbrplatc�etd'oMv-6irse side). FOR DEPARTMENT USE ONLY ----- ----- r ok�� DATE........... REVIEWED BY-- ---- ----------------•- •--- -•---- ---� . ��-----�-��c7�- -- ----------------------••---•------------ APPLICATION ACCEPTED BY.._____. ._.i_- ..-_ - DATE-------------------------------------------------- BUILDING PERIvIITaLSSI]E0------------ Ions and"or recommend frons_______________________ __ -- -_ . --- ...................... ----- --- - ------------------ ---- -- --- -- "`" FINAL INSP N BY:..- - - -- - --- - ------ --- - -- - bate--------7___ --�- �-�-- - - -�----�----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantoca,-Colifornla Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS - '`*"