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FOR OFFICE USE: x�'-------- s--------/--`�-------------- ______________1�1__________�______- APPLICATION FOR SANITATION PERMIT Permit No. r�L� (Complete in Duplicate) � f - -------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ....... ......��..�3 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.�j JOB ADDRESS AND LOCATION. �f � / .. _ . ........ (�� ,----------- Owner's Name--_---_--...-ham---�•A---• '......_.l..a ----------------------------- ----------------------------- --•--- Phone Address-.-------------------------- P— ----•----•-------------- -----------•------------------------------- ••-•••. Contractor's Name---------••-•--- Phone....... _ . .. ................... Installation will serve: Residence�7 Apartment House ❑(ZACommercial ❑ Trailer Court ❑ A otell Q Other ❑ f Number of living units: _!__-__\Number of bedrooms � Number of baths _/.-. Lot size __________6 .._,�1.0. ................. 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 ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted'if public sewer is available within 200 feet.) Se fic T k: f Distance from nearest well_________________Distance from foundation--------------------Material.---------------------------------.__............ No. of compartments------------- ------------Size----------------------------.---Liquid �el?t •------.------------capacity-------------F...a -- -. . - -- - -- - Disposa Fiefc ;bis+ante from nearestlell__`rr_..._Distance from foundofioii: .. _ ,Distance,to nearest lot lin `Number of lines__________ _Length of each line___...S0. Width of trench._____. ... .. Type of filter material. �__i _Depth of filter material,.___- _ ___,.-_Tootal!length_____�_Q-_-- _--__r_�__._.+._ Seepage it: ;�" Distance to nearest w :_Distance fro fou a+ion - rr f II---------------- -. n stanc to nearest lot ilne_ Number of pits___.__ __-___-___Lining material._ P. Size: DiarrSeter____ __ ____________.Depth__.__c+z_;S�___.____.... Cesspool: Distance from nearest well-----------------Distance. rorn foundation._.._______________.Lining material.--------------------------- e:_______:___._______._ ❑ 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):-------------------------------------------------------------------------------------_------------""-'--------------------------------------------------- - --- -------------------------------•---------- ----.._..-------------------------------------------------------•-•---------------•----..._...- --------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r le and regula+ion of the SapJoaquin Local Health District: , - __ _ . .. . _T_.. . (Signed' ---------- - -- - -- -- . •-- �' —Y {Owner end/or Contractor) By---------------------------------------------- - ------- -----_ ----(Ti+le)---------- ----------------------------- -- ---- - ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ON APPLICATION ACCEPTED BY------•-------------- ----------------------------- DATE.------ REVIEWEDBY-------------------- ---------- ------------/-------------------------- DATE------•---------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------ --- ----------------------• DATE_.- Aherations and/or ret mend'ations:_--. - __ ---0 -_- - -__ _____________••-----....._......_ -- _ -- - Y � ----- --- - - -- - - - ----- --- - - - - --- --- - ---- -- -- �Ur/F'- '`''�h- FINAL INSPECTION BY-------------------- L Date i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Strut 205 West 9th Street Stockton,California Lodi,California Mantua,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS