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FOR OFFICE USE --------- . .. ._.`.. APPLICATION FOR SANITATION PERMIT .� , I Permit No. ..1... .f t ------------ - (Complete in Duplicate) �VJ -----------___ This Permit Expires 1 Year From Date Issued Date Issued .. ........ ..�Application is 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 LOCATION-1.6- 4------ u.._ _ Owner's l , .N...a..m. e _ . - Phone ---•----------......-------•-......_.............._...---_......_...___._..... .._..........._......._.............Address. Contractor's Name................�8,<�=--24 .G ----------------•-----------.. Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f-__ Number of bedrooms S.. Number of baths .L.- Lot size ..... Water Supply: Public system Community system Private ❑ Depth to Water Table deft'. € Character of soil to a depth of 3 feet: ❑ Grav I ❑ ndy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(g'f-lardpan❑ s Previous Application Made: (If yes, to/4,._ No New Construction: Yes �f'o ❑ FHA/VA: Yes ❑ No;A r TYPE OF INSTALLATION AND SP EICATI NS: (No septic tank or cesspool perms er is available within 200 feet.) s v SAptic Tank: Distance from nearest well..-.-. .....Distance from foundation-_-/ .........MuatyiaLe,.e-.�.t .r.!` ............ [� No. of compartments___.... ............Size✓_/I'_X__ .__._....Liquid depth...' _'*------------Capacity....Q0......... Disposal Field: Distance from nearest ell--__-.........Distance from foundation.../40..........Distance to nearest lotline.X. Number of lines....___._ ...�,-_____.__��_,,.jj.,,Length of each line..... __._.A--------Width of french...A-,--------------------- Type of filter material.4�41 ,�6�!_'.�_Depth of filter material..--./,___.......Total' length.....,e. ....................... p Seepage Pit: Distance to nearest well---_.'....._..Distance from fou ation._... ..._...Dista c��to nearest lot line. ......... Number of pits..... Lining material....AA Size: Diameter_•__..' .._._...Dept h_ae2T_ Cesspool: Distance from nearest well.................Distance from p om 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 to accordance with San Joaquin County ,.ordinances, State laws, nd rules and regulations of the San Joaquin Local Health District. (Signed) -- � ----- •-------•------------- ---------------- -- ----•---------------•--•------•-•-••---4- omr Contractor) ,By:................................................. ........(rifle)------ — ............................ (Plot plan, showing size of lot;location of system in �afionwells, buildings, etc., can be placed on revers side). FOR DEPARtMENT USE ONLY ' APPLICATION ACCEPTED BY---- ..... DATE_ --' REVIEWEDBY---------------------------------------- -----------------------•-----------•------------------------------------------•--- DATE------...-•-------•---•-------•----••-----•---•••••--•---. BUILDINGPERMIT ISSUED.............................................................-...................................... DATE............................................................. r'IIF ions and/or recom�m ndatl s �_....._-• _ ..-..�--�! ..... .._.. -- •........... ... . U` 0 K+ ---- -Q.-1 ... - C.._f...... p r FINAL INSPECTION BY:... / -- ------------------•------•---------------- Date----- ....... 1.... - 0 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,dalifbrnla Tracy,California E8 9 REVISED 8-59 2M 6'61 ATLAS - -