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,vn yr�IL,G UJC: i J� --------------"---------- ------------- ------------ ------ ------------------------- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. C' ' (Complete in Duplicate) 6 This Permit Expires 1 Year From pate Issued Date Issued ....111J_ 6 Application is hereby made to the San Joaquin Local Health District for a permit to constru an stall the work herein described. This application is made in compliance with County Ordinance No. 5,49. JOB ADDRESS AND LCATION-_."__-YOV __ ZZ" 'or 127 -------------------- Owner's Name"".._"_" -----•- ------ Phone.-" •"----......-•-•-.... Address. Q -------------�'+"vt ------------"" �............................................................. Contractor's Name-. rn ► Installation will serve: Residence CN Apartment House ❑ Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑ Number of living units: _I---- Number of bedrooms .�--- Number of baths _;;._ Lot size ,..7�_,Aov-✓ Water Supply: Public system [❑ Community system ❑ Private IR Depth to Water Ta ZK _ ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam ElClay Loam ,. Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No R 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.) Septic Tank: Distance from nearest wellj__j�----- Distance fro foundation-/b------------.Mate ial " l .------ No. of compartments .; —""'�'''�---� k-�"----Liquid depth------- -------------- Disposal Field: Distance from nearest wellrfO------.-Distance from foundation-l6-----------•Distance to nearest lot line."....__ Number of lines"--- �, _` Len th of each line Type of filter materia � g -"'l��W1dth o 9trenc�--Depth of filter material----f1 -------Total len th.-"Seepage Pit: Distance to nearest we ----Distance from foundation-------------------.Distance to nearest lot fine....-_--__------. ❑ Number of pits Lining material---------------------- Size: Diameter---------------------- Depth------ i -•-- 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):--------------------------------------------- •-------•--.-..----•-"•--------------------•--•------------•----- •-----•--••-----------"-------------- ----•----------•---------------------------------------•---------------------------------------------------------------------•--------•---------•---"------------------------------- -- 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 rules and regulations of the San Joaquin Local Health District. Si ned � J -------------------------------------- --------------- ---- (Owner and/or Contractor) , By: ---------------------...----------••-----...------•-•-------------••-----------------••---------(Titie)-••----------------------------------------- ............. I (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 r APPLICATION ACCEPTED BY _ -p DATE-.d-._1 -7 YR VIEWED BYA"-------------- ----- ------- TE----------------UILDING PERMIT ISSUED DALE. -------------------------"---••----- ---•------ - erations and/or recommend'ations:-_.-_-.-""--.-_."_.." ------------------------ ------•--------- ------------------•--- -•-------- ••-------•--- IJ �Y FINAL INSPECTION By_d/1110_47 --/ Date -- • •--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 203 Wert 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED g-59 YM 5-61 ATLAS • T