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F R OFFIC US __.___..._._... ...................... _-•-.. APPLICATION FOR SANITATION PERMIT Permit No. ...L...:... ._. ./ /f _ (Complete in Duplicate) ( ........i Z- - V This Permit Expires 1 Year From Date Issued Dote 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 Ordi ce No. 549. JOBADDRESS AND LO TION...... j(!',�.L------- - -----, - ------------------------------------------------- --------------------------------------------------- Owner's x�__ Owner's Name----/--- - ---- - - ------ ---------------------------------------------- ---------------•--•------------------------ Phone.................................... Address--......... ` jw--' Contractor's Name........... • . . Phone----••............................. Installation will serve: Residence eAApartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other Number of living units: j-__- umber of bedrooms __.�. Number of baths _ ... Lot size __ _�._r(12. ....•................I.....• Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [3 Clay E] Adobe 2'-Hardpan ❑ Previous Application Made: (if yes,date....................) No New Construction: Yes o ❑ FHA/VA: Yes pi No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: .� (No septic tank or cesspool permitted if public sewer is available,within 200 feet.) //�� Septic T k: Distance from nearest well--_--�'_._. Distan a from f undation__1, l......MatpriaL.L.��JI .............. ( No. of compartments----,�r_________________Size �_��_. ._._:---Liquid depth_._!f!/ ___----------Capacity.-_ -----_ Disposal Field: Distance from nearest well---- ------Distance from foundati ..../D_........ Distance to nearest lot line-.eel,-........ Number of lines........... _______A of each line..... Q�_ j......Width of trench j�!2: Type of filter material 1OL__ ep#h of filter material----A ..__.._..Total length....-�/Q................::....... Seepag Pit: Distance to nearest well------- '------Distance m f ndation...1p�.._..Di � ce to nearest lot lin�_..,,�?-�.__ [ Number of pits.....-------------Lining material.. -..Size: Diameter_----------__-,Depth_ al ............._..._. 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):---------,1�iL✓_ M -•-------------•-•••----••--•-••-----•-••-•-•----------•---••-•--••---•----•------•-•--------••-------------------------------------------------------------------I---------------------------------------- ---- -------- ------- ..................... ..........--------------------------- tir k ...................................................................................................------------------- --------- ---------------------- ---------------------------------------------------------------------------------------------------------------------------•-----------------------•----•------------------------ ---------- 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 gulations of the San Joaquin Local Health District. (Signed) ---- ------ ----------------------------------------- r Contractor) By:---------------------------------------------------------------------- -- - -------------------- --- --------------(Title).... � ' (Plot plan, showing size of lot, location of system i lation to wells, bui ings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- f,. _ l- ----------------- DATE--------- - - ) � �----- REVIEWEDBY---------------------------•- ------------------------------------------------------------------ DATE---------------------•-----------------------•••--•------- BUILDING PERMIT ISSUED--- TE Alterations and/or recommendations:....._ _.�� c" -•.-•__.•_-__.••y----- ' ,j. �.-••.? A ! ----------------------------------------------------------------------------- -----------------------------------------------•----------------------- ---------------..------------------------.--------------------------------------------------•---------- }' - ---------------------- ------------ -------•---------------------- -•-• !7 ' I I XFINAL INSPECTION BYr � - '- - ------- ---- -------------------- Dete ------- .. ----------•---------------•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124-Sycomore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S•59 2M 5-62 ATLAS