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FOR OFF?U --- ------ -__-_._ 1' ..__ _._ APPLICATION`'FOR'SANITATION PERMIT Permit No. ...... .. ------------ ------------------- , --------- • _• (Complete in Duplicate) �1 �j-' Date Issued .___ /d,��.2-- __...-------------------------------1-V------- ------ This Permit Expires,11 Year From 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 LOC TION 'r��ls ......z Owner's Name.'___.: . __ Address................ -•••--•--• ------------------..:_------------------------------------•----------------------•-----.-------------•------------•-----------•--- Contractor's Name-•---& r--•-- _ e '-------•------.......................................... Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ c Number of living units: ----I--- Number of bedrooms ___ Number of baths •>?----- Lot size ----- �f!-._ '.r48°........................... Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Fg—Aardpan ❑ t Previous Application Made: (If yes,date--------------------) No New Construction: Yes [!r`No ❑ FHA/VA: Yes ❑ No EEl' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well__`-a____..Distance from foundation._7C�.............Material__ ... ............................... No. of compartments __ Size... _.�iS�__Y _...Li Liquid de th____ _ ' Capacity 0 P -------- q P. � P tY Disposal Field: Distance from nearest well.dV_._-._Distance from foundation.111?.............Distance to nearest lot line..4 ._._._..... Number of lines------- ________________ ______Length of each line_..._.._...._.._-----Width of trench... ............... Type of filter material.`jE�P.CJ --------Depth of filter material___19-----------------Total length------g0.......................... Seepage Pit: Distance to nearest well_./Q_0-----------Distanc from oundation_710..-±-v -r Distance to nearest lot line....(.•.-__._._ Number of pits-----7..........__._Lining material- /(--.-._Size: Diameter._,3<3_'.--_-_-__-,Depth---_4;U................... 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----------------------------------------------------------------------------•---•----------------------•-----•--•-----•-------------------- r Remodeling and/or repairing (describe)---------- ....... ---- -=---•------•---........................................... _11-J - ------------------------------------------------------------------------------------------------------------------------------------------------------•------------•---.---------------------------- 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 end gulations of the San Joaquin Local Health District. (Signed)..--..---------- --••------ --------- -- ------------------------------------- --------------------------------------------......(Owner and/or Contractor) , BY: ----- ----------- -----------------... (Title) (Plot plan, showing size of lot, location of system in relation to wells, bui Ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______V---Y -_--..____ _ _ ._..._... ------ DATE----- �._ ._...._ REVIEWEDBY---------------------------------------------- ------------------------------------------------------------------------- DATE----------------------•------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------------------- ----------•-•--•----- Ar i d/or recommendations:.--- ---------------- -------------------------------------------------•-••-------•---•-------•--------•------------------......------. 1° -------------------------------------------------------------------------•---•-------------------------------------•-•••••------••-- ---•---•---•-------•-------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- ---- -------- -------------- ------------------- -------------------------------------------- -----------------------------------------------------••-------------------------------------------•---- FINAL INSPECTION BY:l�k _c / y ------------------- Date--- 7._/7- ..------.--------------------------------------------- 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 5.59 2M 5-62 ATLAS yG