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FOROFFICE USE _ - / ' OSS I�f D 1-70 60 6. -- - --- ---- ------ ------------------------1------------------- ----................................................ APPLICATION FOR SANITATION PERMIT Permit No. .4.G 2.L.�— (Complete in Duplicate) Date Issued ---------------------------------------------- This Permit Expires 1 Year From Date Issued ._..._.._:�...6 Z 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 compliancgaaSith County Ordinance No. 549. JOB ADDRESS AA LOCATION.61 - --- --- - --- --- / �1�`� '�` --....9f ... 2fOwner's Na a-- ____ -�- __ Address... /=......--•-•--•=may" -- ... - ' ......�j .f.J......... ---- Phone.//'Ie-....Contractor's Names ....1111•- ---------- Installation 1111-��a2� f Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ........ Number of bedrooms -------- Number baths _'- Lot size ...�................. .... .................... Water Supply: Public system El Community system ❑ Private Depth To Wa Viable ........ 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.) _ Septic Tank: Distance from nearest well-/--f.�_r.Distance fro foundation- -- --..Material.. / C .......... No. of compartments.._-_-.- . ......Size„_ --..-._Llquwd depth..4_K.............Capacity.,.ng7."O..C�4._ Disposal Field: Distance from nearest well/ Distance from fou ndation.�21........Distance to nearest lot line......... .f Number of lines......./_.. ---..-_. _ Length of each line..ZA.. ..............Width of trench----- .......... ......... Type of filter materia. : .` yp �� Depth of filter materlal.,...� .- Total length...�.6._.-1C.../s�............ Seepage.-Pit: - Distance to nearest well'. .............---DistancQ from foundation....................Distance to nearest lot line................. 11. 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------------------------------------------ 0 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)--------- ------ ------------------------•--- --------- `I " ........................•-------------------------------------•-------------------------------------------•--------------•--------• ic7— ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,ZS*aaws, nd rules nd regulations f the San Joaquin Local ealth District. (Signed) ----------------------------- Contractor) By:.......................................................... ------------ --- - ---- f---------------(Title)------------------------- - -------- - ---- --------- .� (Plot plan, showing size of lot, location of system in rel- o _ wells, building!, etc., can be placed on reverse side). FO EPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------- ----------------- ----------- --T__ �'-=""��DATE....... 1 - __e7 REVIEWEDBY--------------------------------------------------------------- ---- 111----1111--••-------------------- DATE.................................................---------- BUILDINGPERMIT ISSUED---------------------------------------------------------------...................................... DATE............................................................. Alterationsand/or recommendations:............................................................................................................................................................... -----•----•••----............................................................ --------•------------------------------•--•••------•--•....•-------•---•--------•------••---••----••------•---••------------------•-•••-•-•---- ...............................--•-----•------••--•--•-•--•---•---•--•-------- ----------------------------------------------------------------_.-...•-•-••----•--•-----•••--------••-------•-----•---------------------•-•- --------------------------•---•----------------------------•------•••-•--------------..---•------------•------••-•---••--••....------------••-------------.....-------•----•--••••--••-------......-•--•-•-------------•-..... . ................................................ ................................... ------------------------------------_-••--------------------•-----------------------------------------------------•-----•-•--•-----•--- FINAL INSPECTION BY: - ..... ------------------ Date--/-/- 7---lam ---1111--•-•----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS