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FOROFFICE USE: . ` -------�- -------- -- ---- - -------- APPLICATION FOR. SANITATION PERMIT Permit No. .._.1.`�:............. �J (Complete in Duplicate) �' U This Aermit Expires 1 Year From Date Issued Date Issued ._ _"_< _!�_T�'_)-- r Application is hereb ,made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. i� JOB ADDRESS AN LOCATION.__.. z ----------------••------------------•--....................------------------- Owner's Name. ---------- -------------` ' •---- - --------=------- PhoneW oaZ3 Address-...I -----------•--------------------------------•-----------------------------------••----------------------- ...................... F Contractor's Name----- su s-----•----•--•---------------------- • -----•--•---------•------------ .__...--------------- Phone..t 4._�f ' Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J___. Number of bedrooms _ Number of baths _ .._ Lot size 194'__JC_As—o._--- Water Supply: Public system ❑ Community system Rr`�Private ❑ Depth To Water Table _W ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay [jAdobe Ha dean C]Previous Application Made: (If yes,date--------------------) No i2( NewConstruction: Yes No ElFHANA: Yes No [] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feeta Septic ;T k: Distance from nearest welle,'1Q14--Distance from foundation No..of,compartments_____.'_--. -. Size= , ----- Liquid depth__.___7 _--.______'Capacity...62eeo�'-'� Disposal Field: Distance from nearest well..--- ----------Distance from foundation__ /A-J___..-.-Distance to nearest lot line.__.... � Number of lines____--____2----------------- Length of each line_.Z6 7--!_________________Width of french______ Type of filter material._. C/ ------Depth of filter material----1_K!----------Total length___..__._�sa�.�__.---------------- Seepage ___--___._ p 9 �- . k See a e Pit: Distance to nearest well____ _________Distance from foundation__—/A-__________.Distance to nearest lot fine___ _____--- Number of pits__.__-_-_ _____Lining material___ Q.0--..Size: Diameter-__33__--------_Depth___--.-_--------- -------------- Cesspool: '_ ` -_ po Cesspool: Distance from nearest well-________________Distance from foundation--------------------Lining material.___.__.___________...______---___.. ❑ Size: Diameter-------------------------------------- Depth----------------------------------------------------Liquid Capacity-----------------------------gals. A Privy: Distance from nearest well__________________ ______________________________Distance from nearest buildi"g_.--_-•--_---------------------------- ❑ Distance to nearest lot fine-------- --------------------- ----••--- t Remodeling and/or repairing (describe)___________________ ..----------------------------------- - --•------•--••------ - -- -- --- ------- --- -• - .-- •- I hereby a tify-that—have-prepated this application and That.the-work-will-lse=done-in-accord artce-with'San Joaquin County ireed ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _ 4{5 - g )------_---------------•-------�--------------------------------------- - --------- ------------ ------------------------.--------------------------------(Owner and/or Contractor) }� By;-------------------------------------------------- ----- -- -- -- ----- Title i(Pl of plan. showing size of lot, location o sys em m re a ton to w Is, buildings. etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i DAT. APPLICAT10N"ACCEPTED BY------- -- --- -- = E-------------- --. � - : REVIEWEDBY - - ••--------- ----------I----------------------------- - ---------'---------------------------- - -----------------. DATE -- ---------------- - -- ---- ---------.....-------- BUILDING PERMIT ISSUED------------------------------------------------ ---- ------------------------------------------- DATE--------------- Alterations and/or recommendations•-.�.r.-3._�.L_:'z---------- r �I • • -----•--�--�----•--�----•'-•----•- --------------------------------------------------------- -. x_ ----------- --------------------- ----------............................................. ...... ------------------------------------------ ---------------I---------- - FINAL INSPECTION BY ..L` L ------------------------------- Date--- = ? .... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West oak Street 124 Sycamore Street 205 west 91h Street Stockton,California Lodi,California Manteca,California Tracy,California Ea 9 REVISED 8.59 2M 5-62! ATLAS ' e Er'' .t ¢