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FOR Oo.-l— CE USE: X f/ "= �-l-"---- -- - ------ APPLICATION FOR SANITATION PERMIT Permit No. .,l -- -- --------- -- (Complete in Duplicate) � This Permit Expires 1 Year From Date Issued Date Issued .i�,l....�� 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. ....__... ... - LQ C Owner's Name-------- --- .......... -- -- ------��l "-Q,. _--•-----------------------------------------------------•-------------- Phone. Address._... -- c- / Ze Contractor's Name ------- Phone................................... -----•--------------- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __`�__ Number of bedrooms __9--- Number of baths _A_- Lot size _1_.QLD.... ...1,F..� Water Supply: Public system Community system ❑ Private El Depth to Water Table _!V ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: (If yes,date.l�12 -5-3-) No E:1New Construction: Yes E] No FHA/VA: Yes [3 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S-ptic Tank: Distance from nearest well_________________Distance from foundation--------------------Material :__.___...__...____........................_._... tic_jgT-!s.,`C No. of compartments--------------------------Size----------------------------...Liquid depth--------------------------Capacity Disposal Field: Distance from nearest well--- .....Distance from foundation...:-?..�'_._. Distance to nearest lot line................. xE29 I I Number of lines___________________ �----------Length of each line____•____'"�_ter------Width of trench__._.__..._._ -__..__..__-------- Type of filter material..,,.-/,— -Depth of filter material----- length..............a_K2_ Y_..•-•_-._--- y� %See Pit: Distance to nearest well_____ C'_.______Distance rom foundation__-_ 1 ._..._...Distance to nearest lot line-...�.._.. Number of pits__.___.I_____________Lining material...__ .Cr_L(---.Size: Diameter.__--_3---3_ -___Depth------ ............ 'U 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 Qv 9 Distance to nearest lot line Remodefing and/ r repairing (describe):_---k _-. � - ----- ----- ---- -- ------- t ----- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------............................................... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances.e State laws, and rules and/ egulations of the San Joaquin Local Health District. (Signed)-, ---------------- ----------------------------------------------------------------------(Owner ) (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 APPLICATION ACCEPTED BY - ---------------------------------- DATE---=7 � �-- --- REVIEWED BY ------------------------ ------ DATE---------. ------ BUILDING PERMIT ISSUED----------------------- DATE ...._._ -- ----- Alterations and/or recommendations:----- _ """" ----- - ----- --- �' ........ -r-E�.................................. ------------------------------------------- .............................................. FINAL INSPECTION BY:4 ._ -•- V ••---- ate--•- ._-•• .... . .............................••----------•--•-•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street E6 9 REVISED 8-59 2M 5-61 ATLAS Stockton,California lodt,California Manteca,California Tracy,California