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FOR OFFICE USE: ------------------- -- - ----- J APPLICATION FnR SANITATION PERMIT Permit No. .. ��... .......... (Complete in Duplicate) - - f' �} �------�-- Date Issued --------------- ----- (,/ -- ------------- I This Permit Expires 1 Year From 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. JOB ADDRESS-AND LOCATION ------------ -f_-?_ Cl.iJ.t. .....Lf _w.� -- -...1 . Owner's Name:-------- �' �--- �'� --�?------------------•-•-------------------------------------------------------------------- Phone----•----•--------------•----------- Contractor's Name... ..-- �.__4/?=---•----------------------------•--- Phone--- = C.9 f Z,%� . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3Other Number of livingunits: ._._... Number of bedrooms ._.. Number of baths .. .... Lot size .__... � — f 1 -............................................. Water Supply: Public system E] Community system ❑ Private Depth to Water Table 0�( . Q'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) NoNew 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.)- - - Septic'Tank:ry Distance from nearest well_________________Distance from foundation....................Material................................. ................ -�k gT r`f`Z No:of compartments--------------------- ___Size------------------------------------------------Liquid deP.th------------...-------.._ Capacity..........-............ Disposal Field: Distance from nearest Welk C -:---Distance from foundation•..:1.Z1---:___-Distance to nearest lot'line...`z-_......... r CcE31/ Number of lines.__.___t.... , '_._____-'__.___Length of each"line....., _ ..`. ,..____.Width of trench-__,_'` •.`..�.___....... Type of filter material..._`._&L'./K----Depth of filter material-__--IS- -______.__Total :Iength_....,_;- .......................... Seepage Pit: Distance to nearest well 11� Distance to nearest lot line.. _........_ �(��_ ...Distance fromfoundation...._ .... Number of pits..`� .-_-. Lining Lining',material.. QC1 _._.Size: Diameter._-__� . :___._...Depth r ._S_ _ ____________ Cesspool: Distance fiom en arest�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--------' `--------------------------------------•------------•----- _:. L � > Remodeling and/oratepairing,(describe): ��-<---� � /L`� ___ _ /tiJ^ T-�- � r ---- ------ - i -- �G c��-_------ ---- .- .` hereby certify thet�l have'repared this applicatio- and that the work will be done in accordance with San Joaquin County ordinances, State I s, 'and rules an regulations of the San Joaquin Local Health District. (Signed). v �� -- -- -.-- -----_- ---(Owner and/or Contractor) (Plot plan, showing size of lot, location of system in relation-fo wells, buildings, et�an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY `Y DATE REVIEWED p BY----------------------- ----------- ----------=-----------------------------------------------•------•--- DATE BUILDINGPERMIT ISSUED...................--------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------------------- ---------- -------------=-------••---•---•-•----•----••••--•------••------•-•-------•------•------•--••-••---- . " --•-�� Y-/-.. ---`� .-.... �7 --------- Date-•---------- FINAL INSPECTION BY:.- - ---- --- . . ........ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-61 ATLAS