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FOR OFFI� US�t w f/t/ I� - ------------------------------------------------------_- APPLICATION FOR SANITATION PERMIT Permit No. .. -x—_771 --------- ------------------------------ ------ (Complete in Duplicate) Date Issued - ---------------- ------------------ -------------------- This Permit Exl2ires 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. ,This application is made in compliance with unty Ordina No. 549. JOB ADDRESS AND LO TION..._ ._ _ _ _ _1_ x1w7�/ e 10 . -----Owner's Name Q Phone. Address.................. 1 Contractor's Name------ - uc-� -------------------------------------------------------------------- Phone................................ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ pfd Number of living units: -----7- Number of bedrooms.. Number of baths .1___ Lot size ._ 1-4 .,, � ____________________ 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 M Clay Loam ❑ Cl [j[jAdobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ew Construction: Yes LSI ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tan Distance from nearest well_ _/----Distance from foundation__40._.-___. ajtenal- __ Y/.C.. ------- No. of compartments....?. . ...............5ize.�S' .. .... ...e....-Liquid depth...:T,;� __ Capacity_____ Disposal Field: Distance from nearest - --._____Distance from foundatior,4&---_........Distance to nearest Jgt//line_____-- ❑ Number of lines--------------ii ---------------_Length of each ^"-----.width of trench.--__-_-_ ff__.----------------- Type of filter material._.. of filter material---At!!________Total length.__/".'.e______________________ Seepage Pit: Distance to nearest well--------__------------Distance from foundation--------------------Distance to rtearest'lot line----------------- El 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------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)________________________ --}-- "'��-.____ _____._______._______- --------------------7 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----•-------------.._..----------------------------- I hereby certify that I ha prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, Stat ws, and le &0 regulations of the San Joaquin Local Health District. (Signed) -._.__ - --- ----- (Owner and/or Contractor) By---------------- ---- ------------------------------------------------------------(Title)-- (Plot plan, show' ize of lot, location of syste , relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------- ---------------------------------------- DATE--------`r E3 REVIEWEDBY----------_-------------------------------•----------------------------------------•---------------•---•----------•-------- DATE..-•--------•-----------------------. ---------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------.__.....----------------------------------------- ---------------------------------------------------------------•--------=------------------------------------------------------------------------..-..---------.....------------------------- ------------------------------ ------------------------------------------- ---- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- 'FINAL INSPECTION BY: Date �--- ------------------ --- ----------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS