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FOR OFFICE USE: , -----_--.----._______________----------__-_-__-_-. APPLICATION FOR SANITATION PERMIT Permit No. _�__ ---------------------------- ------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. /0 a 5 (p 9-1'eq-e� 477.,'/p Are( -- JOB ADDRESS AN CATION.__._-_ a/. _--• - ' _ • ��- - -------- -------- .. t ._ . ��. _ __ . Owner's Name---..... -•----•--- .................. r4 ... ..... : ----• ------- -- Phone....... ----------- - Address a ""-"'-`-------- ---- •-----•--------------- ---------------- Contractor's Name-------- _ /� _..__ Phone --�.3-2'0� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ ______ Number of bedrooms _ 1 f�� X lr��--- � �_ Number of baths ._ _____ Lot size __;................... ��. ._...._ Water Supply: Public_ system ❑ -Community system ❑ Private �r Depth To Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, ' Hardpan ❑ 0 Previous Application Made: (If yes,date______ _____________) No JN' New Construction: Yes ff No ❑ FHA/VA: Yes ❑ Nock � TYPE OF INSTALLATION AND SPECIFICATIONS: i"' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__17`'�___..Qis#ante from foundation._14__________.Material................................................ No. of compartments x __x/d Li uid de th------�................ a--------__-•-. p q P. Capacity. �Q�i� '.-Distance ,� -- er Disposal Field: Distance from nearest welL4�d____ from foundation___________________Distance to nearest lot line---________.•._.. � IV Number of lines______________________ Length of each line ._f _ __ _QVGidth of trench....0... _�______________ � Type of filter material-_ Depth of filter material--/T_"_____-_Total length______s�______________________I.....____ Seeps a Pit: Distance to nearest well_ Q __.___-_DistancefTm fo dation---Al._ __..Distance to nearest lot linee...67.1... [ Number of pits- __ _.___-_-__--Lining material___ -Size: Diameter----2.�-- Depth--- :P-A ---••-________- .�r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- -"�; ❑ Size: Diameter--------------------------------------Depth---------------------4-----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------.---------------------------Distance from nearest building.____._._______________-_-__--.-.____.._. ❑ Distance to nearest lot line-- ---------------------•-------------------------------------•---...----•-••----....----••-•---------------------------•------•--•-------- Remodeling and/or repairing (describe):-------------------------------------- ................-•------------------------------------------------------------------------------------------------- --------------------------------------------------------------....------------------------------------------------------------------------------------------------------------.. ..-.----------------------------- ----------------------------------------------------------•----.--------•----------....-----------------------•------•---------------------------•------------------------•------------------------------------------•------- i ----------------------------------- --------------•---------------------------•-•------------------------•------------------------------------------------------------"------------•------------------••---------------- herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and rules and regulations of +he San Joaquin Local Health District. J --- - ---- - -- -•----- - -------------------•-- Owner and/or Contractor (Signed)----••------•-------�-------•----- J f ( / } By:..............�....e:...... _tom c,t- - ----------- (Plot --------- (Plot plan, showing size of lot, location of s em relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY `�-.,� APPLICATION ACCEPTED BY --------•---....................... DATE........ BY---------------------------------------------------------------•------------------------------------------------------------- DATE.._._.._.._..---------------•-- ....................... BUILDING PERMIT ISSUED----------------------- ---------- ----------- -- ----------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:_--------;� ---2------1!1- --- i 4 ...............................----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- i -------------------------••---•-------•-----------------_--..--..------- --------•--------------------•----------------------•---------.-. -----•------------------------------------------------ ---------------- ----------------------------------------------- -------------------•-•--------•---------------•--------------------------------------------•--- ------------------------ --------------- ------------- ---------------------------------------------------------------------- -------------------------------•-----—--------------------------------- i FINAL INSPECTION BY:-------- Date_.._---- � � j ----------- --- --- ----------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California a Manteca,California Tracy,California E5 9 REVISED 8.59 2M 5-62 ATLAS k �