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FOR OFFICE USE: ------------- ______________________ _ __ --------- APPLICATION FOR SANITATION PERMIT Permit No. ....� . .. ! I- ----------------------- (Complete in Duplicate) �7- -- --"--- This Permit Expires 1 Year From Date Issued 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 with County Ordinance No. 549. 43 JOB ADDRESS AND LOCATIO _o`:-�_-- _-—------------6.................... ........................... ,7 L _t`� �t Owner's Name-- -----[---LI ( ,----- .V.� � --------- Phone..01-21- ----• . Address..... Contractor's Name---- ....................................-----------------------------------------------------..................... Phone................................... Installation will serve: Residence C. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -2:t.. Number of bedrooms -73-- Number of baths _' Lot size ._. ___ ......S___._ .C _.___...._ Water Supply: Public system Community system ❑ Private U� Depth to Water Table A�Sft. ( �J Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)4 Hardpan ❑ Previous Application Made: (If yes,date____________________) No 9 New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SF tic Tan �,��Distance from nearest we 2 {C1 c _ 5 , P ra Distance fro n�foundation___________________.Material___-_______--._--_--_.._... I No. of compartments_ `� Size.___ x Liquid p p ty......I-, Ca au --••---_---.. Disposal Field: Distance from nearest welL.__�-._Distance from foundation.__ .._.Distance to nearest lot li il�- 9r...:.......... gj Number of lines______________----------_,_ Length of each line---------------- -_ Width of trench......`�:.1............_...... Type of filter material...! _ -------Depth of filter material______ ___________Total length_........__......_.----------------------- 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---- •---------......gals. Privy: Distance from nearest well--------------_--------------------------_-------Distance from nearest building.......................................... ❑ Distance to nearest lot line Remod li and/or Z4YJ� an orrrepa!iri'nry1g"(d-e>rsacribe)iL-{ =�4,- ---1c 1-t1SL - 1 J-----_ ---cy ---------------------------------------------------------------- -----•----------------•-----------------••-------------------------------•--------------•---------- ---------------------------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed)._. r 6--.- �_ Z =------------------ ------------------------------- (Owner and/or Contractor) By:.................................................................. -------------------------- -------------------------------------(riitle)------------------------------------------------- -------------- (Plot plan, showing size of lot, location of system in relation to w Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - tit° - 4< ----------------------------- DATE...� ..... --7... = REVIEWEDBY-----------------------------------------------------------------------------------------t'`----------------------------------- DATE............................................................ BUILDING PERMIT ISSUED -------------------------------------------------------------------- DATE. Alterations and/or recommendations:-------------------------------------- --------------------------------------------------------------------------- --------------................................................................................................................................... ---------------------------------------------------------------------------------------------•----------------. -----•---------------- ----------------------------- •-------- --_-------------------------------------------------------------------------------------------------- ------------------�--- / r FINAL INSPECTION BY:----- 17 ��: =r<� =y ;---- ------------- Date-----.1-_.-_V- ..................... ------------------------------------- SAN J&7 LIIN 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 2101 5-61 ATLAS