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R¢FACE USE: -� . t ---------• Q------- r 7 APPLI ATION FOR SANITATION ir,AMITPermit No. ------------------- - (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. JOB ADDRESS AND LOCATION -- t f-----•-- �1c:.... ----°6-------f to T----------------------------------------•--- Owner's Name....-"e---••-)4-------- ---Ct -- -------- Phone-h_4L--3..... Address----------------------------------------------•........ .----L------------------------- ----------------•----------------------------------------------------------------•------------------ ....... Contractor's Name ' . - �/1-° 1.- p_S�� -TP----------------------------••------ Phone. 5 a. .- --f Z_ I:/1-v-- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ®' G y 1v1P Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size _-- 't9.2��_---_ Y R _______.___ Water Supply: Public system ❑ Community system ❑ Private ® Depth ro Water Table __4F�_. 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 M No ❑ FHA/VA: Yes ❑ No [3 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---14°-------Distance from foundation------l-_7.-...--.MatenaL_ No. of compartments-.--.___5X.............Size--------------------------------Liquid depth---------Y---.-------.-Capacity_-. Disposal Field: Distance from nearest well-----------------Distance from foundation----_---------_---.Distance to nearest lot line----------------- Cl .__.-_-.-------❑ Number of lines________________---;.------------.-Length of each line.-------------------------.-_.Width of trench-._----------_------------__--.._. Fi 4 T,r '13o q1 Type of filter material._/AC.Rom --Depth of filter material-----A-a-_--__-.-Total length-,�ad0 S __`',r____ 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):-------- -----------------------------------------•--------------...-------•-------------------•---------------._.-.....----...--------.._...----------• t -•---------------------•-------------------------------------••---------.......--------------------------•-•-----•----------•----------------•-------------------------------•--------•-----••-•---------------------- •---------------------------------------------•-------•-----•-------------•------------------------------------------------------------------•------•------••---•-----•------------•-...------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. (Signed).----•-•-�----- -------if --- -----------------------------------------------------------------------(Owner and/or Contractor) By:_...... '� v-------------------------------------------------------------(Ti+lel !E�' y -- (Plot plan, showing size of Xlocafii�on ,ys+em, in relation to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------- DATE-/-:_-�- ----=-lo - REVIEWEDBY----------------------------------------------------- --------------------- ---------------------------------- ........ DATE--------------------•-•-•--•----•---•---• ------------------ BUILDINGPERMIT ISSUED------------------------------------•-•-=-----------------•---------.-------------------------------- DATE------------------------------------------.---_------------ Alterationsand/or recommendations----------------------------------- --------------------------------------------------------------.-------------------------------------------------------_ ----------------------- ----------------------------------------.._..------------------•-•---------------------------------------------------------------.----------------------•-----------•-----------------•-------------- - ---------------------------------------•---------- ----•-------- ---•---•-----•------------------------• i --------------•------------...........-----------•----------------------------..-.----•------------ ......................•--•------------------------------ -•- --------------------- -`f ---------------------------------------------- ---- FINAL INSPECTION BY:.. --�----- -�-/�-- ------------- Date. ' -/5 (moi ' .k SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wait oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California r Tracy,California ES 9 REVISED 9-59 2M 5.62 ATLAS J