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-1 I-UK UI-F]C� USY. e -------------------------------------- -------------il.. APPLICA N FOR SANITATION PERMIT Permit No. -- ----------------------------------------------------i1i !!I: 110mPlete in Duplicate) ---------------- ate Issued ... -- --------------- ------------- - This Permit piries I Year From Date Issued W 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work ribed. This application is made County ith in co'�'npliancqaXC nty Or finance 5,49. i JOB ADDRESS An LO ATIO ------- --------------- ail ........ . ...- Owner's Name_ ...... - - -------------- ------------ --- ------- ---------- Phone U.. .. Address..,,---------------------- -_------------- -- ------- ----- - -------- --- ------------- Contractor's Name... ;r.. 1. Installation will serve: Residence ZN Apartment House E] Commercial [3 Trailer Court (] Motel E] Other 0 0 Number of living units:I/.. Number of beclrooms-�_ __ Number of baths,,,,/-- Lot size .... Water Supply: Public sysfemi V1 Community system [] Private i *d—_Depth to Water Table ........ ft. Character of soil to a depth of.3 fee+. SandV*,Gravel El Sandy Loamjk�4 Clay Loam ❑ Clay [] Adobe❑ Hardpan [3 Previous Application Made: (1114es,clate--- ----------------I No 13 New Construction: Yes)g�No [3 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 wellv--------Distance from foundation-Za---------Material...... -------- No. of co ''Il�partments---Z-----------------Size..5z..",X36 Liquid dep�h__u/.2_!'_. to - ------ opacity.... Disposal Field: a Distance fr,o'm nearest well_. �eo 6_q1'__._Distance from foundafion..,/P........Distance to nearest lot line__..z Number of Ilines---- ------- ------------Length of each line.aq .....6_9_ Width of Type of filt r maferi.1.41-4 ---------- ......Depth of filter material--- '________Total length-_--------1-2--a--------------- coy - Seepage Pit: Distance to' .nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_...____......... El Number oflp its----------------------Lining material-------------- --------Size: Diameter_.._.__...------_-------Depth----------------•---------- Distance from ------ Cesspool: �om nearest well-----------------Distance from foundation-------------------- Lining material____....__...__.___.___...____.....__ 1, ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-----------------------_--gals. 11! Privy: Distance from nearest well--r-------------------------------------- -------Distance from nearest building-------------------- :11! 1 ------_--------- ❑ Distance to nearest lot line---------------- Remodeling and/or repairing �C,-,escrib'e):--------------------------------------------------------------------- ........•-•-------•---------••-•-•------------------ ---------------------------------------------------------------------------------------------------_------------------------------------------------- -------------------- --------- -------------------------------------- ---------------------------------------------------------------I------------------------------------------------------------------------------•----- •-----•------------------•------•------------------------------------------------------------------I................I........................I-----------11------------------------------------_ I hereby certify that I havt prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws and rule's and regulations of the San Joaquin Local Health District. (Signed).... < ,44��......... ------- -4-4-1 Efe-C.;. ------------------------ ----------16WWffl"qW" Contractor) $y----------------•-------------------- ----------------- --------------------------------------- ------- (Title}---------- (Plot plan, showing size of lot, location of system in relation to --------------------- ----------------------------- ................. Is, ild ng el I , bu Iding efc., can be placed an reverse side). /s i1c FOR DEPARTMENTUSEONLY APPLICATION ACCEPTED BY ---------------- DATE REVIEWED BY 111i --------------------------- - ---------- ----------------- - ----------7--------- --------1----------- DATE------------ BUILDING PERMIT ISSUED....... ---------------------- ----------------------- DATE Alterations and/or recommendall ions:___---------------- -----•-••------•------••------------------------------1.1------------------------------------------------------------------------------_-------------------------------------------------------------------------- -----------------------------------------------------111i --------- ................................... ----------------1 - - ------------------------------------------*----------------------------------------------------------------------------------------------------------- !------------------------------------------------- ------------------------------------------------------------------------- .......................................... ................................. - ----------- -------- ------- - ----------------------*--------------------------------------------------------------------------- ------6�--------------------- -, ?/.I — I FINAL INSPECTION BY:--------- ------------------- Date / I ---------- --------------- ----------------- SAN JOAQUIN LOCAL HEALTH DIST.ICT 130 South American Street 300 West Oak Sireat 124 S 0 Street 205 West 9th Street Stockton,California Lodi,California Motor— ,*cc,California Tracy,California ES 9 REVISED 8-59 ZM 5-6t ATLAS