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FOR OFFICE USE: _ --------------------------------- / ------------------ APPLICATION FOR SANITATION PERMIT Permit No. .. --------------- / ----------- --- - -_-- --.--------_--_- (Complete in Duplicate) Date Issued . _.z"..� - -------------------------- 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 withC,��ty 0inance No. 549. ,el2p 7"0 4',57-11V JOB ADDRESS AND LOCATION.?ga��_._ '-------------------------------- • - Owner's Name----------.?4.:.WX!F ,40C------ /r --------------------------------------------------------------------------- fc�/V -----------•----------------•--- Phone../ Contractors Name--------- :__./��..:___$��.!l�_!�S_1P1�.��_.-.�----.- Installation will serve: Residence Q' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms _�_Y_ Number of baths __/... Lot size ..75�..i1'.....Z57k?-. Water Supply: Public system ❑ Community system ❑ Private [R Depth To Water Table 1.�.. ft. '[ ❑ El `��, Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam Clay Loam Clay [:] Adobe❑ Hardpan❑ �1 Previous Application Made: (If yes,date--------------------) No 2 New Construction: Yes ❑ No Ej,_ FHA/VA: Yes ❑ 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--_---..--_...--.---------_----.---.--_-._..__--. No. of compartments------------- ---------•.-Size.---------_------------------Liquid depth--------------------------Capacity-•----------------.... Disposal Fielct. Distance from nearest well_��-_----Distance from foundation...L5.75-.........Distance to nearest lot line....„-.)...... Number of lines-------------/-- ---------------Length of each line--------75•---N--._.Width of trench........�©•.. ..--••-- Type of filter material--- -----Depth of filter material----Z ___-..... length....................7-1`J___.......... Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line.................. ❑ Number of pits---------- ---------- Lining material- -------Size: Diameter.........--•-----------Depth................................. Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth.----------------------------------------------------Liquid Capacity--------------------------•g Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building-----------------------------------.------ ❑ Distance to nearest lot line--------------------------------------------------------------------------------_-------- -------......................................... Remodeling and/or repairing (describe) --0.0 .... .orzs_rz -----f-5!S S = 1----=----------•-•-------•--•------ ........................................... -------- .fir --•------ ----------------------------------------------------------W......W------------------------------------------------------------W-------------------------------------------------------------W----------W------- 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 rules and regulations of the San Joaquin Local Health District. ------ ......................(O ner and/or Contractor) W Ti+le (Plot plan, showing size of lot, location of ys+em.in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONL APPLICATION ACCEPTED BY -- € DATE ' .. --------- ----------- ------------------ _ _ REVIEWEDBY------------------------------------------ .- ----------------_--- --------------- DATE BUILDINGPERMIT ISSUED.............................................................. -----------------•... DATE.........------------------------------------------------- Alterations and/or recommendations----------------------------------- --•--------------•-•-•"•"-------- -------------------------------•--------------------------------------- -------------------------- ----------------......... .............................................. FINAL INSPk4AQN B . - -- - - ---- ---- -- ---_--------- Date---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Stmt 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9.59 2M 5-62 ATLAS