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FOR OFFICE USE: -- -----��-�-(�-3- --�-- ----- — — _ ----- `f/Cly _-___�;'.'L_. APPLICATION FOR SANITATION PERMIT Permit No. .. �-- S.S ------------------------- ------------ (Complete in Duplicate) Aq/ -------"--- 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 Ordi ante No. 549. JOB ADDRESS AND LOCATION.----- --4.93 0 ---------------------- -------------------------------------------------- Owner's Name , --- --- _G ) Phone Address--------- ------•---- ---------------•----•--------_---_.. ------------------ Contractor's Name.---- -- ----•----------—---�--------•------------ ----------------------------------------------------•-------------•------ Phone................................... Installation will serve: Residence ff� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms •4-- Number of baths A— Lot size _/�_�2__._X---- -_______-•-------------- Water Supply: Public system ❑ Community system ❑ Private [►Depth To Water Table ft.>ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e Hardpan ❑ Previous Application Made: (if yes,date--------------------) No [t"' New Construction: Yes [!rNo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet t Septic,Tank: Distance from nearest well4o_.._...._Distance from foundation_i�a------------.Materia ................... No. of compartments-------2,.-----.--------Size-_-__�_x/0X(5------Liquid depth__4-------------------Capacity._/i� .�.p� P --b 1 Disposal Field: Distance from nearest welh�.............Distance from foundation... .d___--------Distance to nearest lot line.-5—.1....... Number of lines-__.-_-_ Length of each line___. _D ` ' r7 - ---- - -- - 9 �----------------------Width of trench-----••--•-��-••--•--•-----------••- Type of filter material_�e.C._-____-_Depth of filter material---.� ''.`_......__Total length------- . a________________________ Seepagg Pit: Distance to nearest well__4b6__f.---------Distance from foundation-----I..i-------Distance to nearest lot line. f.. .._. Number of pits---------,'t!----------Lining material_�Q_C_/__Size: Diameter._.3 ..._...._.Depth----_Ar---•--_-_-_----- Cesspool: Distance from nearest well-----------------Distance from foundation_-----------------Lining material-------------- Size: Diameter----------------- --------------------Depth--------------------- ---------------------------.-Liquid Capacity----------------------.-----gaIs. 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 a d that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of e S Joaqu' Local Health District. (Signed)------------------------------------------------------ --- ------------ ----- - - -------------------------------------- ------------------------(Owner and/or Contractor) By: (Title)_ (Plot plan, showing size of lot, location of systemifn relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- - -- --- DATE. I-------- -----•--------•--•----------- REVIEWEDBY----------------------------------------- --"-----_-------------------- ----------------------------------------------------- DATE-------_------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE---------------------------------- Alterations a /or recommendations:----------- ------------ ------------------------------------------------------------ .............. ...------................ ...... --==---------�---- r----•, c-� e a- ---•------------------ - - - ---------. ------ ' ------------------------------------------------------------------------------------------- ---------------------------------------- ----------------------------------------------------- -------------------------------- ,< r2f-r� --------------- Date------------------•--- `s 6 FINAL INSPECTION BY:-------- -------`---------------- -- - 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 ES 9 REVISED 5-59 2M 5-62 ATLAS