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r KVt-l-IcL USE:+ A-3-------------------- j,------------------_---------------------- _-_. APPLICATION FOR SANITATION PERMIT Permit No. ._t................... ---------------------------------------------- 0 7------------------------------- (Complete in Duplicate) (� . ------ This Permit Expires 1 Year From Date Issued 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 County Ordinance No. 549. m 4- JOS ADDRESS AND LOCATION , _- � - ----- �° = - -=� ------- �— Owner's Name------- •---------•- ••--_...•• -------- ---._. Phone..y��d-,�..� ,ey Address - --- -------------------- -----------------------------•----••---------•----- --------------------------------------------- Contractor's Name - ------------------------•.---•--- Phone-----------------------------•--•-- Installation will serve: Residence ©Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___. Number of bedrooms ._--A---Number of baths ___L_ Lot size ..............!__.__........ _... __. -----------___---_ CIQ s Water Supply: Public system,[] Community system ❑ Frivate jo Depth To Water Table .7 ft. O Character of soil to a depth of 3 feet:, Sand'' Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ (.� - Previous Application Made: (If yes,date--------------------a No [•} New Construction: Yes ❑ No 2 FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:-- (No septic tank or cesspool permifted if public sewer is availableifhin 200 feet.) Septic Tank: Distance from nearest well_._.-sh` __Distance from foundation..-_�--'_a--------Material------- _ . No. of compartments_..___.- -----_-Si e-------�,e-,3��4::: Liquid depth----�----------------Capacity------ - Disposal Field: Distance from nearest well-_- � Distance from foundation____„7.5?...._Distance to nearest lot line_-__-__--5-.5) Number of lines____. `�_____ 1---. I� -__.-___Length of each line____ �'__L7________.Width of trench.__...________'?....__ Type of filter mKaterial'. - -__Depth of filter materia___�f _%/____Total length____........ *.... ,--4P- ........ Seepage Pit: Distance to'nearest well----------------------Distance from.,foundation....................Distance to nearest lot line................. ❑ Number,of pits-----------.x--------Lining material------------------------Size. Diameter------------------------Depth---------------------------- ...� Cesspool: Distance from nearest:well-----------------Distance from foundation--------------------Lining material__-_____._-_-._____--________-_...... ❑ Size: Diameter-------------- De --------------------- Liquid Capacity gals. Privy: Distance from nearest well- _.`' ----___-..__.-__------.__--Distance from nearest building__ \1� -----� �1 ❑ Distance to nearest lot ltine___`_ yr5:5_T �sf _ _ Remodeling an /or repairing (describe�:___ 6 _ -------- .---••-----------••-----------------•-----•---- `• � ' �v ----•-- - ------------- hereby certify that I have prepared this application and -.= a,_ ---_X �' -- -•-•-•--- ffiaf the work will be done in accordance with San Joaquin County ordinances, Staf ws, and rules and4relions f the San 3oaquin Local Health District. � � / }Com - i51 Red•-----------• _.--- ----`�'/(✓,(,_ r "------------------------- 't ( 9 -------------------------------------•--•--------------••---- -------(Owner and/or Contractor) By:------------------- -- ----------------•-•----------------- ------•-----...-------------------------------•--•----------------------..(Title)---------------------------------------------.....----- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,.can-be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ DATE • L— REVIEWED :BY... ------------------------------------------------- •-------------------- DATE-----••-- •----------- BUILDINGPERMIT ISSUED-------------------------------------------£ ---------------------------------------- DATE------------------------------------------------------------- Alteraffloo and r recommendations:______-.__- 'IF - / ----------------•-•-•-••--•------------•--•-•- ---------------•------------ --._.. ryf�hr�..----- � r� -[------16"'----- =. ---- ---��- -- 4- 5�.. '_.. . G •-- ------------ -- ----' ' ----._....--••--------- ---- -' -•---------------------------------- ----------- -------------------------------------------- -----= - - ------ --.--- ------------- FINAL INSPECTION BY--------------------------'--- :---v S Date ------------ ` �"'�.... ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Woof Oak Street 124 Sycamore Street 205 West 91h Street �1 Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISFU 8-59 2M 5-62 ATLAS 71