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FOR OFFICE VSE- --------- --------------- ------ ----------------- SE:___ _____%..--_-.-.-__-_.--..--._----___-_-_-. APPLICATION FOR SANITATION PERMIT Permit No. .. '... -------------- ------ -- - (Complete in Duplicate) "T� Date Issued ._ .. !� . --- ------------------------------ ---------------------- This Permit Expires 1 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 OCATION....� --� !.it ----------------------------------------------------------------------•-------------------- Owner's Name....... - ---- --"--- -- . . + - 0 ------------- - Phone.................................... --------------------------- Address......... ... .. �e_. --••- -•--------------••--- --------------------------------------------------•••---•-------.......................................................... Contractor's Name -------------- ---- -- �� Phone................. ....... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __ Number of bedrooms ._1j�. Number of baths _0_*7_-.. Lot size _4-Q,".. .......................... 00 Water Supply: Public system ecommunity system ElPrivate ❑ Depth To Water Table A7 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe @2- 4ardpan ❑ Previous Application Made: (If yes,date--------------------) No &'-New Construction: Yes ❑ No U�—FHA/VA: Yes ❑ No I❑-,iC` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,p ,o ( v Septic Tank: Distance from nearest well----- -_..Distan_ ,11-4,X*� c from foundation._�sr�........Material__&.&__,9./_/. ........ ,7❑/ No. of compartments..., ----------------SizeOZ' Y _'Liquid depth__.__"j_4 _�� ---.-___-____Capacity.ZZAK?.... Disposal Field: Distance from nearest well Distance from foundatRn�f�..'_........Distance to nearest lot line. Number of lines_______ ____-----__________,_��__�_. Length of each line______ ...............Width of trench..Z........._.................. Type of filter material .Depth of filter material--s ,A----��-----Total length.....zez�---,o ............... Seepage Pit: Distance to nearest well----------------------Distance fr m fo dation...1?4-/...Distance to nearest lot line.___"_-... ❑/ Number of pits.-____A---.-__--:Lining material._ P -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.......................................... ❑ Distance to nearest lot line-.-------------------------------------------- Remodeling and/or repairing (describe) ---------••--------------•------•-----------------•-----------•---------------------------•---------------------•-------------------------------•-----•------- ----•-------------•-•--•------•------••---••-•--------•---- -----------------•--------------------•----•---------------------•----------------------•-•••-•-------•------•----•------•-------•••••---•-•----•-••---•------------•---------------•-••--•-.---•-•......•-••-•-••----------- ----------------------•----------------------------••------------------------------------------------------------------------------•---------------------------------------------------------------------------------------- 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, an rules and regulations of the San Joaquin Local Health District. (Signed)............. � . ----- -- --------- - -�r Contractor) By:---•-------•---•-••--•---•-----•-•-•••-••----•-••-------•---------- -- ------ - --- ----------------------(riitle)--- -�� - ---------- --- -------- (Plot plan, showing size of lot, location of syste In relation to wells, buildings, etc., can be placed on reverse side). // FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY <�'------- �.<='= DATE --•r _2........... --- REVIEWEDBY--------------------------------- --------------- ---------------------------------------------------................ DATE........................................................... PERMITISSUED---------------------------------------------------------------...................................... DATE............................................................. Alterations and/or recommendations:------ ---- - ------------------------------------------------------------------------------•--------•-•----------------------------- - --- -------- ---------------------- ".l.T=- ....------------....- .--- ---D-i •-----------------------------• " 1'� --------------------- -----------------------------------------_._-- - ------------------------..y----.-----------------.--------_________.. ------------------------------------------------------ 17 ....___ ....._ ._............ --___------- •----------- - -• -•---------• ------------------------------------------------------------�----------�---- -------------------------------------------------------------------------------------------..................................................... FINAL INSPECTION BY:---------- -------------------------- Date---------------- -�3 ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wort Oak Street 124 Sycamore Street 205 Wort 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS