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_KI F - -e. - _.► ------------------------ ------------- - --_- _______- .AP I.ICATION FOR SANITATION PERMIT Permit No. .../ ----------------------•----- } (Complete in Duplicate) - ------- --------- This Permit Expires 1 Year From Date Issued Date Issued .-f/�6�'2-- 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 wi Ordinance No. 549. JOB ADDRESS AND LOCATION._____ Owner's Name........ _. ._ • --------•-•-------•-----••--•-•• ....................... Phone............... Address..-.. - .Fld ..,l'7 .._._, T ! -----------------------------•--•--........_.. ._..---...--------.......,. . -QT_- _ - - -----•---------••- Contractor's Name___ '�? 'eY-- -------------------------- ------•--------•--- .............................. Phone-•-- . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -:4 Number of bedrooms .9... Number of baths .Z ,l < � -- Lot size ._.��_./._.��.......................... Water Supply: Public system ❑ Community system ®/Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay,Loam ❑ Clay❑ Adobe lo' llardpan Previous Application Made: (If yes,date----------_---------) No g?' New Construction: Yes 1?'(`lo ❑ FHA/VA: Yei4 @3r--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well____"^"'-__--Distance from foundation__.. -_..-.--Material___-•�%- -_ �� .v f` .......... [9'" No. of compartments_____ --------------$ize �,J�aS�_, �j/Q'�iquid depth_..,.'��__.-_____•_--Capacity.l,-— Disposal Field: Distance from nearest well________________ Distance from foundation.__ -.._:_.Distance to nearest lot line..0 �_---- (B®' Number of lines...... _._._ Len th of each line_ /___ _ Type of filter materia . - .� bb p 9s,�_ _ <� Width of trench.__.' ---�-•................ C- Depth of filter material___, -------------Total length...... .................... Seepage Pit: Distance to nearest well______ _______________Distance f om fou dation____Ze.......Distance to nearest lot line.47.�..- Number of pits.....o�-----------Lining material__/ke4,'-Size: Diameter.N,Z3•��-••--_Depth !____-__--_•••• ' Cesspool: Distance from nearest well_________________Distance from foundation__--___-.____.___..Lining material-_._____-_.._____ _.__--_--__----- ❑ Size: Diameter------------•--------------- ------Depth----------------------- -_Li Liquid Capacity. - 9 P ty gals. Privy: Distance from nearest well_________________________________________-------Distance from nearest building ❑ Distance to nearest lot line------------------------------------------------------- ... Remodeling and/or repairing (describe):------•------- .. . J -4' -•----•----•••----•-----•••••------- ----••--•--•--••-••----•-----•--•---•••-----•-•-------•---•-•----•--•----•--•-----•---•-------•-----------•---_..__..•--•-••---••-••--------•..•---•-•-••------••-•-----•--•-•--- 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, a d rules and regulations of the Sen Joaquin Local Health District. (Signed)-----------I ... ..... -. By= ( a*orContractor) rile (Plot plan, showing size of lot, location of system i r ation to wells, buildings, etc., can be placed on reversee)----------------------------- FOR DEP TMENT YSE ONLY APPLICATION ACCEPTED BY- `_ ____ - -- _-_ ,__-•-_ ' •---•- DATE-••- REVIEWED BY -- ------------- DATE__. --•-••••-••-.._.._...•-•-----•--- BUILDING PERMIT ISSUED 7lter tion end/or recommendations:..... -,iQ. -- :•'-•-... _... FINAL INSPECTION BY:... ----------- Date__-.-__-. .__ Z/ — SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street - , 144 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-61 ATLAS