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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ...�..___ _ Q?. _ --------------------- (Complete in Duplicate) Date Issued ---�-.z o-_ y This Permit-Expires 1 Year From Date Issued --- --------- Application is hereby made to the San Joaquin-Local co al Health District for a permit to construct and install the work herein described. This application is made in complianf�TTr . unty Ordi`' ce,r 1jo. 549. JOB ADDRESS AND LOCATIO � :.._.....:..l�.'-+�C.Ss Owner's Name.....---- ••- _---------'!'-� , � \ �: Fh�S- 5/.7z-��'y b .:• ---------------------------------•---------------------------------- one. .......... Address............. '7,r 23------ Os` � Y - _y- ----- --- ------------------------5--------3-----------Y--i-- ---•- : Contractor's Name-----. F1i--A S ------- \ � --------------------------------- y •---... Installation will serve: Residence Apartment House ❑ 'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j----- Number of bedrooms' .-,9' _. Number of baths ;:k---- Lot size --.- - - Jcr s Water Supply: Public system ❑ Corrimunity\system ❑',Private ® Depth To Water Table _------_ ft. Character of soil to a depth of 3 feet: Sand ❑ \Grev I ❑`�Sand' Lom ❑ Clay Loam 0 Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date -------------- ---J No ❑�'New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ;.� �-' ` � , � � (No septic tank or cesspool permitted if public suis available—within 200 feet.) Septic Tank: Distance from nearest well-/14.-- -----Distance from foundatuio`n../]ik. ..--.Material_--- ------1---6--0---0-----C----y---- No. of compartments--_---- -------------Size............. Liquid`de1th--------------------------Ca acitY -, Disposal Field: Distance from nearest well-/#?0-......Distance from lioundation-_-4o------_---.Distance to nearest lot ❑ Number of lines----.-_--------------------------Length of each line---------._--...-------------Width of trench.f d.'Xs6'------------- ,�L Type of filter material....&a_ .-_-Depth of filter material--!Y------------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 foundatiE on--------------------Lining material...-------------------------_------_- � ❑ Size: Diameter--------------------------- ---------Depth----------------------------- ------Liquid Capacity---------------------------gals. ` Privy: Distance from nearest well---------------------------------- --- -----Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line- ----------------- + Remodeling and/or repairing (describe)------------ ----------•---- ------------------------•--..................................--------------------------------------------------------- ----------�1w----------------------------------------,--------------------------....-•-----------•---------------------------------- U -••;----- - - ----------------------------------------------------------------------------�A-----•-----------•---•---------------- 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) � y1T/roN ---.50 ractor I-Owner and or Cont By:------------ - - ------ -- - ---------------------- - ----------------------------------------------------------- _(Title)------------------- ---------- ---------......--------------- (Plot plan, showing size o Ion o ystem in'relation to wells, buildings, etc., can be placed on reverse side). 9 FORD P USE ONLY APPLICATION ACCEPTED BY-- -----_.-. --------------------.-DATE...... -------------------------- � REVIEWEDBY------------------------------------------------------------------------------------------- ------------•---•---•----.._.... DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------- ...... DATE.---- ------------------------------------------------------- Alterations and/or recommendations-------------------------------------- --------------------------------...--------------------------------------------------------------------------------- -------•--& . �� ..._.. K" _ -------------- ---------------------------- - ------ ------------------------------------------------------------------------------------------------ ------------------------------------ ---------- --------------- r FINAL INSPECTION BY - ---- --- ------ Date---------- L'fl 4 7 ----------------------------------- ��SAWJOAQUIN 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 9-59 2M 5-62 ATLAS