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Oki FOR OFFICE U E: — 3a, : ------11 1 - APPLICATION FOR SANITATION PERMIT Permit No. ____.f.:S.P (Complete in Duplicate) G ---..____________________________________________________ This Permit Expires 1 Year From Date Issued Date Issued .----.-.T.•.._l_`:{°� 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. I'L ✓)b L•4 D S 7" ' JOB ADDRESS AND OCATION.. - � _ ...- -•-------------- -•---------......................... Owner's Name C- _--�-'�, ------ Phone.............---------------------- .—- -;!��, Address / Contractor's Name------ Phona? '�P.._ �'P17. � lnstellation will serve: Residence E] Apartment House E] Commercial ❑ Trai rr ❑ Motel C] Other Number of living units: ________ Number of bedrooms -------- Number of baths,._____ Lot size ... /X .....?L--�-�~ -------- Water Supply: Public system ❑ Community system ❑ Private;�3 Depth To Water Table A-Q_ ft. Character of soil to a depth of 3 feet: Send Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ ('(1 Previous Application Made: (if yes,date--------- _._._} No E, New Construction: Yes)r No E] FHA/VA: Yes ❑ No M, TYPE OF INSTALLATION AND SPECIFICATIONS: // (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellZOP___--Distance from foundation___ ._______-Mat7ial_ ._ �-.*;4 No. of compartments_____--------------Size__ x `?� ____._:...Liquid depth__,/Z�--.___._CapacDi posal Field: Distance from nearest welte -.Distance from foundation.. d........_.Distance to nearest lon _...... . Number of lines..... -__-___ ._Length of each line____•_•5742--',7 of trench..____, ��....................._ Type of filter material./.j'- Depth of filter materia!___,l> __.______Total length____________________ Seepage Pit: Distance to nearest well------_---------------Distance from foundation------------........Distance to nearest lot line.........___-___- [] Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------.-.-.----.----••--------- 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------------------------------------------------ -----....-------------.----------.-.--------------•-•----....----------••---•-•-------------- Remodelingand/or repairing (describe):-------------------------------------- --------------------••-------------------------------------------------------..........-------------------..---- ----------------•---------------------•----------------..-.......--------------------------------•----------------------------•---------------------------------------------------•------------•----------•-•----------------- I hereby ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tat laves, aria rul snd regulations of the,,5aWJoaqui LocalHealth District. (Signed)- - -------------- ---•----- ------ ------ ------ - ------------ ------------------ - --------------- nor and/or Contractor) By:.....---•-----------------•--•-------- --------------------- - -----------I-- ------ --------- -----------.(Titl ----- ---- -•---------- ----------- ... . . -------..(Plot plan, showing size of lot, location of system in relation dings, a c., can be place on reverse side]. FOR DEPARTME USE ONLY APPLICATION ACCEPTED BY..------- t ------------------------------------------------ DATE........ ->..---- •-------------- REVIEWEDBY-------------------------------------------------------------------------------------------------------------- ...... DATE------------------------------------------................. BUILDING ----------------------- -- BUILDINGPERMIT ISSUED----------------------------------------------- --------------–-------------------------------------. DATE------------------------------------------------------------- ' Alterationsand/or recommend'ations---------------------------------•---------------....-------------•------------------------.....----••-•------------•--••-----.---__-.---•------------------ �y ---••--•-----------------------------------------•---------------------------------------•----------------------------------•-----.----------------..-............_..----•------------------------------------------------- ---- ------------------------------- ------------------------ --------------•--.-----------------------••------------ ---•-----------•--•----•-------------------- ---------------------------------------- FINAL INSPECTIONBY:. Date------------- f w y SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California EA 9 REVISED 6-59 2M 5-62 ATLAS