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FOR OFFICEPSE: -- ------------------ -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....:......._ .......... ----------- .: _ ------ ----------- {Complete in Duplicate) 7 l !e _.-_.............:}--_ ------- This Permit Expires 1 Year From Date Issued Date Issued --_-_--`4.4 ._.. Application is hereby made to the San Joaquin Local Heal h District for a permit to construct and install the work herein described. This application is made ( �o�mplliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---aO,. '4rh �``' -'FE```Z Owner's Name-----14_i .,. Phone----------------------------------- Address----------- .. =--'--- ----- - ---- --------- - - -------------------------------------•--------•------•---------------------------------- -- - Contractor's Name------ 7.5 .. Phone_______________________ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I... Number of bedrooms -3--- Number of baths _e�,- Lot size _190' --a�'.--__.__.________________________ Water Supply: Public system ❑ Community system Private ❑ Depth ro Water Table . _o- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay ❑ Adobe ❑ Hard p ❑ Previous Application Made: ;If yes,date........... ...... ) No [&--New Construction: Yes M--flo ❑ FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet.) Septic Tank: Distance from nearest well-lnf?k1 ---Distance from foundation_...18- t------Material � ------------- No. of compartments__ -...............Size--.-t.a" � _FU----Liquid depth-------7-0- ---_._Capacity...,/,!IQC-------- Disposal Field: Distance from nearest weiln - _.Distance from foundatin.- .. *-"y.Distance to nearest lot line_ [lam Number of lines- ............. . .......Length of each line---_ .Q. ----------------Width of trench.-------- ."__----- ------- Type of filter material._. P_kA.........Depth of filter material----- .-� __........Total length-------f _ - _-_--_.__--._ Seepage Pit: Distance to nearest w 1i_.lhc �_____Distance f m foundation_f ___Distance to nearest lot line__5� '� [ � Number of pits...___ l-__-_-__Lining material.- _C_ ___ Size: Diameter.___._33. Depth........%L `-'-------------- 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 j i i4�cr --t---u--. ----Y . ,-_- --{=�--- ark -.'---.- Rertlo eling and cr repairing (des ribe� .... . tc Zi --.--- : ._...- -- - -----•----------------- ----------------------------------------- --- - -- '----- -- -- . . -------- I hereby certify that I have prepared this application and t at 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. (Signed)-------------- -------- --------------------------------------- -- - - ---- ------ --- --- -----------------.._...- ---------------------------------- ------(Owner 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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------ DATE----- �/ � .. ---------------- REVIEWEDBY...................... - ----• DATE---- ------ -------------------------- ---------.- BUILDING PERMIT ISSUED------------- ---- ------ -- ----- ---------------------- DATE----------------------.-------------------------------------- Ah ra io and/or recommendations:.. .... ---------- ------------------------------------ ---- 2j - JCJ3� - -- ----- �Z ---------------------------- ---------- --------------------- ----•------)-- � -- --------- -u-- -�-v-`---- ------------- ------------------------•---------------------- -- - - - - - ---- -- - - - - --- -- - - -- - FINAL INSPECTION BY:._____-c"�� - OCAL HEALTH DISTRICT 130 South American Street 300 west Oak Street 124 Sycamore Street 205 Wed 9th street Stockton, California Lodi, California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS