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FOIZOFFICE USE ____:----- ------- -- -------------- APPLICATION FOR SANITATION PERMIT Permit No. ... ----- ---------------- - (Complete in Duplicate) `-,.«" Date Issued ---- --------l-_----- — This Permit Expires 1 Year From Date Issued .� Application is hereby made to the San Joaquin Local Health District for a permit to cons rust and inst511 the work herein described. This application is made in compliance wi h County Ordinance-No. 549. F JOB ADDRESS AND L ATION.- = -----------• - --- l ' / Owner's Name------------ --------••--------•--------------------------=------------- ----------------- Phone.........................--•-------- Address......4W. ...... 4. 4 Contractor's Name----------- ----- - ---------•-- •--••------------------------------------------------------------------ Phone................................... Installation will serve: Residence (Apartment House ❑- Commercial ❑ TrailQr Court ❑` Motel ❑ Other ❑ Number of living units: j-_- Number of bedrooms.-- Number of baths/�_ Lot size> Water Supply: Public.-system ❑ Commu city system Rgeo"P"'rivate ❑ Depth ro Water Table--oaf/--ft. Character of soil to a depth of 3 feet: Sand ❑ Graveh❑ Sandy Loam ❑ z Clay Loam ❑ Clay ❑ Adobe [£Hardpan ❑ fPrevious Application Made: {If yes, --------- No I,2r New Construction: Yes Wr'No ❑ FHA/VA. Yes R?---No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.] E Septic'T k: Distance from nearest w II_---_-r"`_'_:Distanc/�tfrom Andation----ff.�...__..._-.Material---- _ ! -.--..../. w. No. of compartments- ------------------Size4Ll-__,l� -1-�iquid depth__-_--#- -------------Capacity ------- Disposal eld: Distance from nearest well_________ ______Distance from foundati n....IQ....__._Distance to nearest lot} line--- ......... Number of lines......�1_---- -__ ----_ .__Length of each line_'. __, ...... ...--.Width.of trench.-.�e-_- ------------------ ----- Type of filter mafeii02 / D r_Depth of filter material_-A7-�---------Total length...AW----------------------------- 1�J Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- & : µ ❑ Number of.pits:----------- -----Lining material-----------------------Size: Diameter-----------------------Depth----------------------------------- Cesspool: Distance from nearesi'well-----------------Distance from foundation...-------------.-. Lining material-__-_.:----------.-----_----_----_ P. Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity. --------------------------gals. Privy: Distance from nearest well--------------------------_-------------_-------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-- --- -----------------------------=------- - ----------------•- ----------------------•--------------- ol - - - Remodeling and/or repairing (describe)== = •..................... ......................................... -------------------------------------•---------------------------------------------------------------------- ...............••..-__--------•------------.-....--.._K-_...---------------------------------------------••-•---------------------------------••------------------------..-._-............--....---------------------------- . u J 1 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. {Si nod � •�»- -----w�---^--r-— _... ,. 9 )---------------•--- { - 7�r Contractor) ' - / (T e� t Y• itl �1 ' (Plot plan, showing size of lot;location of system ' relation to wells, buildings; etc., can be placed-on reverse side). FOR DEPARTMENT"USE ONLY APPLICATION ACCEPTED BY-----C ---- - ---- ------------- - - ____-_-_�- # '` , REVIEWEDBY------------------------------------------------------------------------- -----------I-----------------------------------------I DATE----- BUILDINGPERMIT ISSUED--------------------------------------------------- -----------------------------------------------._ DATE----- :----------------------------=----------------- Alterations and/or recommendations:-------------------------------------------------------------------------- 1 .�-- ------------ -------------------- ---•-----------------------------------------••-- ; 11 ------•-••-----•--- ------------------------------- ' FINAL INSPECTION BY. lr�__ . ------------------- Date------- =------ ¢'-------- -------------------------------- SAN JOAQUIN 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 a-59 2M 5-62 ATLAS i i