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FOR OFFICE USE: ---------------------------- ----------- ------------------------------- ---------- ---------_-_____.___-_-___-_____________________ ______-___ APPLICATION FOR SANITATION PERMIT Permit No. ._f... .:� �. ----------------------- (Complete in Duplicate) ----------------------- - --- �... ------ --- This Permit Expires 1 Year From Date Issued Date Issued ...__.1.. :,:_t ,9 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 LOCATION C�N------e"F-- � =-p- -------------- r�11� CG,RNE?, ��`; Owner's Name------ ' 1 L Phone one Address..............10-: ...._��---0`.�------.. Z�Z.i-------------' ---�T �- rp Contractor's Name........d7_Wf\1.F_.BA...------------------------------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel ❑ Other [—]Number of living units: ---I--- Number of bedrooms .-7 -Number of baths J----- Lot size -__ .................. Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 1:e0` Character of soil to a depth of 3 feet: Sand R!r' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Er" New Construction: Yes No ❑ FHA/VA: Yes ET' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q Sept�Tank: Distance from nearest well__N�N59 .Distance from foundation----/ ..........Material...l:1. 2D............. nNo. of compartments--_---._------------- ___Liquid depth_-- _t--------------Capacity.....—�2..... Dispos -Field: Distance from nearest well-&-d-N-P-__Distance from foundation._h........ Distance to nearest lot line....-'-'? ..._.... Number of lines_-.____`Z-------------------Length of each line._ .Width of trench-----'�2__ ....... :: _ Type of filter material...FC_�{\...Depth of filter material-__- ___...____._Total length-----------7-...�_--------_--•-__--.-_ -•------ Seepage.Pit: Distance to nearestwell__KONTN�----Distance from foundation...... .____.Distance to nearest lot�line____-�)--_---_--- Number of pits------- --------------Lining materiaL_R.C'L_( .__Size: Diameter-------�_r---..3.-.._..._..Depth-----CC...................... Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El -__--_ ,-__-._-----.---__•__-_---_❑ Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Capacity.........................---gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building.......................................... ❑ Distance to nearest lot line------ ----------------------•------------------------------------------------------•--------------------------------------------------------- Remodelingand/or repairing (describe):......................................................................................................................................................... ---------------•-•---------.- --•--------------•----------------•-------------------------------------------•----------------------•-------------------------------•----•- •----------------------•---------•----•--• ------ --.•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----•----------.---------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rugs Tad,regulations of the San Joaquin Local Health District. (si ned 'v g )•----- - -=---------------------------------------------------------------------------------------------------------------------------------------------------(Owner and/or Contractor) By:....................................................................................................................................(Title)---------------------------- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �r APPLICATION ACCEPTED BY------ --( -L-- cam, --------------------------------------------------------- DATE----- / � / ---- � REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------ -----------------------------------------------------------------•--------------•----------------------------------------------- --------------------------•--- --------------------------------------------- -----------------_-_ -------------- -------------------------------------------------------------------------------------------------------- -----•------------------------------------------------- ----- ----- ----- - -------------- --- - -- -- ------------------.---------------------------------------------- - � er FINAL INSPECTION-BY _ -aj-- ------ -- Date----------, ------------------------------------- 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,California Tracy,California E8 9 REVISED 8-59 2M 6-61 ATLAS