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FOROFFICE.,USE: 11 _� �� 24 --------------------------------------------------------- --------------------------------------------------------- .APPLICATION FOR SANITATION PERMIT Permit No. .f.�'..._..f..... -------------------------------------------------------- r (Complete in Duplicate) --------------------------------------- ------------------ This Permit Expires 1 Year From Date Issued Date issued .................. � Application is hereby made to the San Joaquin Local Health District for a permit to construct andinstall the work herein described. This application is made in compliance with County Ordinance No. 549. ��d�v .1474 JOB ADDRESS£AND LOCATION Owner's Name--------M.s<Q.r_- ` ?? � -------------------------------------------- Phone Phone---•-•---- -------------------•--- ---- ---------------- ------------------------ Address•-------,� 1 ------ Contractor's Name----•-----•---j--------- .G....... .. -------------------------- ,f.�C........._.-•----...._.. Phone _Y•u'�.-Z..--c Installation will serve: Residence Ej�'_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other B' Number of living units: _.1---_ Number of bedrooms _02L. Number o baths ',A Lot size _.e�.A4 x--. .................. Water Supply: Public system ❑ C'mmunity system F1Private Depth to-Water Table/,52—ft. x Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑. Previous Application Made: Of yes,date--------------------} No ❑ New Construction; Yes ❑ No FHA/VA: Yes ❑ No ❑., ' TYPE 6F INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) q 6D',sp, ank- Distance from nearest well-----------------Distance from foundation-_._.f.-_.__........Material....--.•....•....• N :No. of compartments--------------------------Size----------------•-------= ---Liquid depth_-------• •---------------Capacity------............ sal F'r Id: Distance from nearest well..5 0- -- Distance from foundation....Xa_........Distance to nearest lot line... .......: Q Number of lines---!_- _--- -------- -------Length of each line-------.�s-'_-------------Width of trench---.-.P2 -------- Type of.filter material--- A-' Depth of filter rnat6ha'I_.--1X- ...........Total length......... __.L5................ Seepage Pit: Distance to nearest well----------------------Distance from foundation____.I..............Distance to nearest lot line----------------- t ❑ Number of pits---- -- - -Size: Diameter----•-------------------Depth----------------•-----••-•---- ------------------Lining material------------------ ' ?� - --- Cesspool: Distance from nearest well-----------------Distance from foundation- .._.-.-._..---.Lining material..................................... _ El Size: Diameter---------------------- -- ----_ .._eth__ _• ----.•:"-•-•--.- "1---- Liquid Capacity ..--- gals. Privy: Distance from nearest well------------------------.----------------------Distance from nearest building------------------------------------------ F-1 Distance to nearest lot-line----------------------------------------------------- ----------------------- ••----•-----------------------------------------•--------------•- Remodeling and/or repairing (describe)------------------------------- I s ------------ -•-•-•---------•-•-------•------••----- } t• t 4� . . 1 , 1 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i. ordinances, State ws, and rules and regulatigns of the.San Joaquin Local Health District. ! :-;. -------- f------------------ Owner and/or Contractor ` -- - �1--- �'...Title y ( )------------------ ------------------------------------------ (Plot plan, showing size of lot, location of system in relation to yells, bui Ings, etc., can be placed on reverse side). t 1 FOR DEPARTMENT USE ONLY 1; APPLICATION ACCEPTED BY..--.- --------------------------------------------------------- ---------------------------------•------------------- - DATE-----1 t- Q -` ------- REVIEWEDBY........................................--------------------------------------------------------------------------------------DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------------= DATE------------------------------------------------------------- Alterations and/or recommendations:--------------------------------------------- ---...... ------------ ----------------------_----_-------------------_---------------------------------- ---------------------------- --- -----------------•-•-----------•-----------•--------•------•••---------------------------••-----------------------------••----------•----•---•---•........................--•------------------------------------------------ --------------------------------------------------------------------- .-.._.».-•--------•---------------•----------•---.------------•- . -------------------------------------------- --------------------------------------------------- --•------------------------------ ----i: FINAL INSP N BY:-'" _ Date` _ _.'(�l-/............. r 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 5-59 RM 5-61 ATLAS