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FOR OFFICE USE: ---------- ...""---"... - ----- ------------- APPLICATION. FOR SANITATION PERMIT Permit No.A.;Z- .../..._) s: . fsr 5. ------ (Complete in Duplicate) This Permit Ex ires 1 Year From Date Issued -- ---- ----- -- 7 ---------- --------------- -- Date Issued , 7� 1 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---.-•_._. Owner's Name-------- �C --------------- - o ...I -•----------•---- ----- ----- Contractor's Name..._____•------1-._.__.. Phone•............... ------ - ----------- -- --- ---------- Installation will serve: Residence` Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _/-_-- Number of bedrooms .Zn- Number of baths L0 size ------ ............. Water Supply: Public system X Community system ❑ Private ❑ Depth TO Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam ❑ 'Clay ❑ Adobe ' Hardpan E]Previous Application Made: (If yes dote____________________) No 9 New Construction. Yes ❑ No2t' FHANA: Yes ❑ No71— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_.- Distance f m foundation_AQ-�.---.Material__..__ .. --- ----- No: of compartments..... .------- ----------Size______.. __a_KrL-*Liquid depth------�------------Ca capacity tY Disposal Field: Distance fromnearest well__--Distance from foundation.. ___ Ar �!�-..___....Distance to nearest iot line___L�___-.--- Pa Number of lines_____________1 Length of each line__.%7<�'_'--��--•,Width of trench._ �� Type of filter material.. __ depth of filter material___ r --- 1�:r__._.Total length Seeps a Pit: Distance to nearest well___-,10617 Number f�rjm fo dation_0-----------Distance to nearest lot line---- _- Number of pits--- Linin material _Size: Diameter ."�, r' Lining - -------- _ :Depth----�•_�._-••---••---- Cesspool: Distance from nearest well_________________Distance from foundation-__._ -------------.Lining mat erial__._____.__.____:_______. " i Size: Diameter------------------------------------ Depth---------------------------•----------- •--------Liquid Capacity gals. -9 Privy: Distance from nearest well--------------------------------------------.----Distance from nearest building ----'•-----•----------- C/ Distance to nearest lot line___________________-_ Remodeling and/or repairing (describe)_-------------------------------------------- i --•-•-----••---•-•-----•------------ ------"----------------------- ------------•--- i - •- - --- --• ------ ---- --- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin Coun+y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------- __"_.- _(Owner and/or-Gentrae#� -- ----------- BY: ------------------------------------ ----------------------- ----•----- - ------------ Title of 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.------ ,/� ��' REVIEWED BY---------------------------------------- DATE---------------- •"---- --------------------------- -------------• ------ BUILDING PERMIT ISSUED------------------------------------------------------------------------- - ----------•------- ------------•----•---------------•---•--------••--------------------------- --------- DATE ---•- Alterations and/or recommendations------.......... """ "" :.........:................-----------•--------=---------------- --------- .._....__....___.__________________ __----------- ------------- ------------- ....... ------------------------- --------------- ------------- ----------------------�/---------------------------------------------------------------------------- FINAL INSPECTION By,_ d Date l --------- SAN JOAQUIN LOCA&EA H DISTRICT -)------------------------------------- 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 91h Street Stockton,California Lodir California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS 4_