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FOR OFFICE USE: �� APPLICATION FOR SANITATION PERMIT Permit No. ._.1. .r�. 7 _..... ------------------------------------ / I ---._-- ----•---------------------------.-------------- (Complete in Duplicate) Date Issued _ _____________-___..._______.___.._- .-_ This Permit Ex ires 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 described. t This application is made in compliance ?ih County Ordinance No. 549. JOB ADDRESS AND LO TION..n- ,' _ /1 J................ -- --- .... -- ------.....� _ I tQ f r --------- - Owner's Na ---- ------------ -�="---•-�..------. . ------ ----------------------••----- --------------•---------..------------ Phone- - IC/ , t Address_. .... ..._.. - -----------------------------------•--------------------•-•--•---------------- ._...----------- Contractor's Name--.- � ,-•-••-•--- -••-•---- - - ""^"s .. +tit-'`-fro.- ` +�rC,.• Phone. -rA. Installation will serve: Residence ®�partment House ❑ Commercial d Trailer Court ❑ Mot Other ❑ Number of living units: -1----- Number of bedrooms _�_ Number of baths _...1_ Lot"size ._. ___ lr_ -mac.....____.._ \1 Z_ - Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table ' .. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ *%4k; Previous Application Made: (If yes,date--------------------) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No [g TYPE OF INSTALLATION AND SPECIFICATIONS: R (No septic tank or cesspool permitted if p#ic,sewer is available within 200 feet.) Septic Tank: Distance from nearest well-4-0-------Distance irom foundation---1.6-----------M teriai------------------------------------------------- No. ______________ ____________--.....------..____-No. of compartments.--__--.---------------Size_ _ .Ir-- __ --x- Liquid depth___t ... r5---------capacity------ isposal Field: Distance from nearest well________________Distance from foundation---.----------------Distance to nearest lot lin .. . Number of lines..................-----------------Length of each line--------------------..........Width of trench------------------------------------ Type of filter material----------------.-------Depth of filter material.----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well_____----------_------Distance from foundation--------.-----------Distance to nearest lot line____-__.-___-.--_ Size: Diameter Depth--•---------------•------------- ❑ Number of pits_____________________Lining material----------------------- ----. Cesspool: Distance from nearest well_________________Distance from foundation._-----------.-----Lining material..----------------------------------- 11 Size:.Diameter--------------------------------------Dept h--- ------------------------------------------------Liquid Capacity-------------_---_-----gals. Privy: Distance from nearest well_______________________-.-_.._.___.___-_..._--_Distance from nearest building------.......--_______-_..__----____.____. ❑ Distance to nearest lot line-----------------------------------------------•--_------------...._ ------------------------------------------------------- Remodeling and/or repairing (describe):---------a"xat-4.'i -2.- ttte ------------------- ------------------------- --------- --------------------------- •----- ----------------•--••-•-----------•--........--------------------------------...------------------------•---•--•-------------------------------- -•-----------------------------------------------------------------•------------------------------•--------------------•------------------------------------._-•----•------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc a laws, and rules and regulation of the San Joaquin Local Health District. (Signed_ ------ ----`----- ... .--- -J - ---(Owner and/or Contractor) B . ` . = -- ----------- -•a�.�Q+�-�,------ `..... = trtlel By:_ -_.�(Plot.plan,showing_size o t,.Iocation_of-system.In.relation-.t i..wells,buildings,rete.,-can-6e_placed.-on-revers -side). FOR DEPARTMENT Up/ONLY 16 r�r � � APPLICATION ACCEPTED BY----------------------------------------------------------------� ---� ------- DATE-•-----•----l r ._..------ REVIEWEDBY--------••-----------•----------------------- ----------------------- ------------------------------j----------------------- DATE----------------------------------------------------------- BUILDING ------------------ ------ BUILDINGPERMIT ISSUED--•----------------------------------_-----•----------------------------------------------....---- DATE------------------------------------------------------------- Alterations and/or recommendations;--------•------------------------------------------------------------------------------•--•---------------------------...----..__._---------------------------- S ___________________________________________________________________________________________________________________________________________________________________________.........__________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ I ,I ..............._e___.._____._...__...-._....-._...._____...________.-_...._.-_-_--.--------....___-__._______.._._____._._.-.__..___-__________.._._.___..____.__-______.________._____.___..___._.___-_...___._____.._._____ FINAL INSPECTION BY:.--- - -- -- - -------------- Da+e... � ' ¢ '� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore 5fr"t 205 West 9fh Street Stockton,California Lodi,California Manteca,California Trary,California ES 9 REVISED B-59 2M 5-62 ATLAS