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FOR OFFICE SE: � - 7 ------------ ir ff ^_�G ____.__ APPLICATION FOR SANITATION PERMIT Permit No. _._�_:��._... l - (Complete in Duplicate) / t Date Issued ---- This-------------------- - ---- --- --------��-- -------- 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:,appiication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION...__ _._- .---. -••--.-•--------- _. _ ' ' Owners Name �7 !!-- -- .. . ----------•----------------------------------------------------••--•--.---------------------------- ��fA_ � �__ -- one-----•------------------------------ Address Contractor's Name ` -7--••--------------••---...------------...---------•---------------------------------------. Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -._.� Number of bedrooms _Z_ Number of baths d...... Lot size ---7/X,__2-2 Z Water Supply: Public system a Community system ❑ Private ❑ Depth to Water Table .....__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe tj- Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 91"' New Construction: Yes EP,`fio ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: aLNd,septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ti6'T-an ` , � p *k: Distance from nearest well--t from foundation_to..............Material_. I� "/ No. of compartments----------- -----------Size-.-.-_- - -9-----Liquid depth__'If-- --------------Capacity---- --0_Q . I Disposal Field: Distance from nearest well____"'__-_-...Distance from foundation.___/Q...........Distance to nearest lot line-,-f------------ Number of lines----------I------------------------Length of each line-70----------------------Width of trench--_4&1----------------------- Type '--------------------_Type of filter material._.`TDG.�---------Depth of filter material....._r �!--------Total length......94_-°__.......____-------- Seepage Pit:Pit: Distance to nearest well'__-_-------------Distance from foundation__fig?-.—.24..Distance to nearest lot line__S ....... . ®� Number of pits_____I----------------Lining material..._7m k-__-Size: Diameter__._..� ? ---___.Depth______.... '..______. a Cesspool: Distance from nearest well-----------------Distance from foundation___-----------------Lining material-------------------------------- ❑ Size: Diameter-------------------------------•-----Depth----------- --------------------------Liquid Capacity----------------------------gals. i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------_-_------__-- --- ❑ _ Distance to nearest lo+ line_..______ ___________ __ , i Remodeling and/or repairing (describe):--------------•--------------------------------------•-----------•------------------------ -•----------••-------- -------------------------------------------•----------------•--------• -------••------------..._-•--•------•- ------•----•-•---------------•-----------------------•------------------•---------•-------------------------- 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- egul ions of the San Joaquin Local Health District. (Signed) ----------------- ---- - ---------- -------------------------------------------------------------------- ---------------------(Owner and/or Contractor) BY - --- -------------------------------------------------------------(Title)------------------------------------ tz Piot Ian, showing size f p g on of syste in relation to wells, buildings, etc., can be placed on reverse aide). r��,;., FOR DEPARTMENT USE-ONLY APPLICATION ACCEPTED 13Y__/ter--�--__ '_" ------------------__ DATE -----•f----------•------ ------ REVIEWED BY------------------------- DATE--------------- BUILDING PERMIT ISSUED---------- -------------- ----- -----------------------------------•---•--- DATE. --- Alteratonan,d/ or recommendations: -------- --, t-- Li �/��7� C�/� �Z__/l�C/� �� '• --•---------•---------• --•-•-------•------------ --------•-------•-- --------------•----------- FINAL INS PECTION BY:, L - ------ Da+e ._. - ,� -.. .- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Servet 124 Sycamore Street h 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS