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FOR OFFICE USE: r ' ------------- APPLICN FOR SANITATION PERMIT Permit No. ...../........ ------------------------- -- ----------------•----------- (Complete in Duplicate) -------- This Permit Expires 1 Year From Date Issued Date Issued ......... ..I7...... ©S-- 2_`7®—1 y Application is hereby made to the San Joaquin Local Health District for a permit to construct and ' st the work herein described. This application is_made incompliance:. 'th1founty Ordinance No. 549. JOB ADDRESS AND LOCATION. .(. r -a ' _..•.-- _ __-.-• •,/-- Address ' ---- Owner's Name j >� ------._--_-------------------- ------------------------------------------ Phone..------------•-----.----•- ----.........•mac... ---�6. ----------..lwl . Contractor's Nam .r. --------------------------------- -----------------------------------.--•---------------------------•.......... Phone................................ i Installation will serve: Residence q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 Number of living units: --- Number of bedrooms -------- Number of baths ::._:_. Lot size ,C e�TlLt------7n ......A....__. l Water Supply: Public system ❑ Community system C] Private Z Depth to Water Table -�. ft. II Chaaacter of soil to a depth of 3 feet: Sand ❑ 'Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe ❑ Hardpang Previous Application Made: (If yes,date--------------------) No 2] New Construction: Yes W] No ❑ FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: � �- (No septic tank or cesspool permitted if'public sewer is available within 200 feet.) 'k 1 .1 Septic Tank: Distancecompartments ,nearest�w' -- ----------- Distance ndatiMrial.-Com Noof compartme ts_ ._____ ize t iine. _. ...-.-.•.-.. S —Liquidep __ - a acifil_--P -...r Disposal Field: Distance from nearest ell Distance from foundation../U ---_--Distance to nearest lot Number of lines--- 9 -______...__f.!_ _ Length of each line----/__�_____ _______Width of trench.-4-91-'v-------- a Type of filter material --_ a�paDepth of filter material-----I_JF..........Total length_._I-Fq............._-. Sege Pit: Distance to nearest well_ -n_�-- :--_-_Distance froma,foundation__1_= ...........Distance to nearest lot-iine �.............. I 'r Number of pits----11-------------Lining material/4_+---------------t.Size: Diameter__.,;t.-- `.---.----- Depth-----r::----I.........•........ Cesspool: Distance from nearest well--------;^ -----Distance from foundation--------------------Lining material_____.____--___-____-_____.......____ ❑ Size: Diameter,__-I R------s-------------------------------------._Liquid Capacity ...._ als. . �jk P tY 9 Privy: Distance from nearest well..=.__._.`_.___�_______________"e______t_____Distance from nearest building.............................. ❑ Distance to nearest lot line- ------------ Remodeling ine --------------- --------------------------------------------- ---------•---= -=------ Remodeling and/or repairing (describe):___L /-C1_.`_ `_ / 1 I I ------•'-------`----------------- -•--•-----.._.._.c..---•---•----•---•------?---------------- ---••---------_---- t------------------------------••-- --------------'.__._... .---._.----------------.-.....-- --I :-:P.... . ---------------•----------•--...---------•-•-----------...------------------------------------- Ii\ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County p ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)y -------• -------- k ( y ( 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). 41 9 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY/,0!f--- - �t ---------------- ---•------------------------------- --- DATE------ ---------------------------- REVIEWEDBY------------------------------------- ------------------ ----------------------------------------------------------- DATE BUILDING PERMIT ISSUED--------------- -------•------------------------ •--••------------------------ DATE. Alterationsand/or recommendations- ------------- -----------•--------------•- --_-_-----•----_-----•--•-----....------------•------------------•------•----•---------•----- f ----------------•----------- ----•-----•---•.......................... --•--------------------------------- FINAL INSPECTION BY _ ---------------------------- s SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California d1entefa,California Tracy,California ES 9 REVISES 5-59 2M 5-6[ ATLAS