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FOR OFFICE USE: ., 3uIy/ -- I. >., APPLICATION FOR SANITATION PERMIT Permit No. _Z-.........j_•_ r ------- (Complete in Duplicate) !3�� a Date Issued ---==-----------�. Z.._ ---.-_------------II/ - --------------- -- --- 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 iiss�maaddeTli�mmpXl a with County Ordinance No. 549. meq_ �p 2+� /Jc A.)- , JOB ADDRESS AND LOC/ATION. 3 �� ----- ................................................... Owner's Name-- ------ A 92-------- ----------------------------------- ------•----------------------------•--- Phone............................. -•--- Address -------------------------••---•------••-----------•-•-- Contractor's Name 7S --------------------------------------------------------- Phone......•--•-------•---- -•-•---•--11,----------------------------------------------------- Installation will serve: Residence M_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_-1___ Number of bedrooms ` ---- Number of baths A_.-__. Lot size ............................... Water Supply: Public system ❑ Community system ❑ Private [Depth ro Water Table&�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardptan'❑ Previous Application Made: (if yes,date---------- ----- No n` New Construction: Yes,B'No ❑ FHA/VA: Yes D---No ❑ 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-5 '__-__-----Distance from foundation______............ 0 sr . �. No. of compartments_______',I----------------Size-----3__ ' --'C--q------Liquid depth--__-`1- --------------Capacity---- e�i�W Disposal Field: Distance from nearest well.:5_ _'__ _Distance from foundation....�q-f........Distance to nearest lot linef' _`__.•..__ ~ Fy, Number of lines------------3--------------------Length of each ...................Width of trench-----j___- `-cif-----•--.-_------•-- Type of filter material.�71S2L'K--------Depth of filter material__( ...............Total length.._. / `______________________ Seepage Pit: Distance to nearest well- ,T©.�--.______Distance from foundation___��'.._r.__.__..Distance to nearest lot line_r�r_�__:__. 0— Number of pits--r--------------Lining material__"�P_ -l_-___.Size: Diameter 33-.............-Depth_ --------------- � Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-----------------------------------_�. n ElSize: Diameter------------ ----------------------- Dep+h-----------------------------:-----------------------Liquid Capacity-:------....................gals. r fPrivy: Distance from nearest well-------------------------------------- - - -- -Distance from nearest building.. ...----...------------------•---------- ❑ Distance to nearest lot line------------------------------------------------•------------------___._-----•--•----------------------- ..._ ------------------------ Remodeling -------------•-------Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------- -------------------------•-------------------------•--------- .. - _ ---------•--•-•---------------------------------------•-----•-------•-----------------•-------------------------------•----------------------•------•------------•----------• �- 1 hereby certify that I have prepared this applied#ion a d that the work will be done in accordance with San Joaquin County j ordinances, State laws, and rules and regulations off/he 5 Joaq n Local Health District. 4 1 --- - •--- ------ Owner and/or Contractor) (Signed)------------------------------------------------- s ( I By------------------------------------------------�------- -----' ----------------------------------------------------------••(Title)---------------------------------------- -- -- -- ----- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 07. APPLICATION ACCEPTED BY------------- ------------------------------------------------ - ------------------------ DATE REVIEWEDBY--------------------------------------------------------------------------------------------------- ------------------------ DATE------------------------------ - - BUILDING PERMIT ISSUED-----------------------------•--•--- -•------------------------------------•- DATE-------------------- ----- +�• �, l� �'a =�----- �-� ,� _, �f Alterations and/or recommend'ations:�.�1+�-r+--��-r.'�-�'I"--------•---...-- -- ---•-••-•--+�"�-------------•• a --T�'c"C �-7"--^- ' -If•---------- -'----'��`r -----------•--------- --------------------------------------_----------•------------------------------------------ ---------------------------------------------------------------------------------------------_--•--------------------------------------•---------------------------------------------------------------•-•-•-•-------•••--- ------------------------------------------------------------------------------------------------------------------------------------------------•- ---------------------------------- -----------------------------•--- J FINAL INSPECTION BY:.A� ---- --_ ------------ Date--- ---•-•---- =-----•---------- ----------- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wed 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS