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FO,�OFFICE U�E: / A. 146- --—------- j. --- ----- ------ APPLICATION`fOR SANITATION PERMIT Permit No. ------------ ------------------ (Complete in Duplicate) -------------------_ 1.1/1 .- I This Permit Expires I Year From Date Issued 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 LO TION Owner's Name......? ------------------------------------------------ ----------------------------------------- Phone.................................... Address..................L.�01A_ Contractor's Name------ -- --------------- -------- ...................�.,...................... Phone................................... Installation will serve: Residence URO"Apartment House ❑ Commercial El Trailer Court 0 Motel 0 Other ❑ Number of living units: j__ Number of bedrooms A--- Number of bathsZ... Lot size AWX' .JA_Z2........................ Wafer Supply: Public system g?"'Community system E] Private [:] Depth TO Water Table AlKeft. Character of soil to a depth of 3 feet: Sand 0 Gravel [] Sandy Loam E] Clay Loam 0 Clay [I Adobe Er'Hard Previous Application Made: (If yes,date--------------------) No �r' New Construction: Yes [] No FHA/VA: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic,Tants, Distance from nearest well_________________Distance from foundation........._..__.._..M No. of compartments-----_-------------_--Size--------------------------------Liquid de .................. p�h_' ify................... Disposal Field: Distance from nearest well__-:_-___--_Distance from foundation...IA*e*?. nearest lot Number of lines........./---------------- Length of each line_ of trench---A. ..................... 4-W Type of filter maferial_/�_�' '-_ Depth of filter material__2 ..-Total length......4,0----------------------------- ........... Seepage Pit: Distance to nearest well------ —---------Distance from foundation-_Z .........Distance to nearest lot line.- Number of pits--- --------------Lining material../eV40e__.Size: Diameter_,;� .........Depth._,_,�_'0................. Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material------.............................. 0 Size: Diameter--------------------------------------Depth-------------------_--------- Privy: Distance from nearest well-------------- ---------------------Liquid Capacity............................gals. El Distance to nearest lot ----- ------.Distance from nearest building.......................................... /- -----------;.......................................................................................... Remodeling and/or repairing (describe):--------------1921.14 -----Q(_ !`__1 -�_ __14!0 -------------------------------------------------------------------------- .............................................................................................................-------------------- _111-------------------------------------------------------------------------------------- .........................I...................................I.............................................................................................................................................................. -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------......................................... 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 r les and regulations of the San Joaquin Local Health District. .4, d3 n (Signed)..................` _. . __ -1 oill 4AI) -- -- --------------Q9 ------- -------- ----------- ----------------( ter Contractor) itle)....4,0r�,W ......... By:......................................................... ---------------- ------ .. --- -------- (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc., can be placed on rove-rse__side)........ ---------------- FOR DE!JRTMENT USE ONLY APPLICATION ACCEPTED BY- -------- —----- ------ -- ---------------------- ------------ ...................... DATE... & ----- ----- - ------ REVIEWED BY-------------------------------------------- - ----------_----------------- ----------------------------------------------- DATE BUILDINGPERMIT ISSUED--------------------- --------------------------------------------------------------------------- DATE...................................... Alterations and/or recommendations-,----------- ---- -- e ...... - --------_------- -0- .... ............................... -------------------------------------------------------------------------------------_------------- ............... ................................................................... ..............I.............. ........................................ -------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------... ............................................ .. ................. . ----------- ------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY i A---- �--- ---- Dote.___.& ------ --- SAN --------------------------- J'OAQUIN 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 E9 9 REVISED 8.59 2M 5-62 ATLAS