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TOR OFFICE USE: lit. "` �7/ ------------------------- ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .................... -- --------------------------------------------------------- Duplicate)-om lete in Du cate (� - �CP P }'" I '------------------------------------..--.----.-------._-_ This Permit Expires 1 Year Froin Date IssuedDate Issued ------f _ Application is hereby made to the San Joaquin Local Health District for ja permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549.. CC 7� JOB ADDRESS AND LOCATION_ ��___/ �®-�---r..m ----g------ Q RR-�----- pp---(_�--- Owner's Name---------------�_�� ----------FES---------------------------- ----= -----•-------------------------------- Phone.... Address ..1. J..------73CJX ZZ:9-P 0 -------------- •-----......----.. ..................................... Contractor's Name------•-------0-W.MF Phone- Installation will serve: Residence 'Apairtment House ❑ Comne'cial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: . ___ Number of bedrooms .3. Numbef of baths I___ Lot size ....AC.Rg_1>_G1�..................... Water Supply: Public system ❑ Community system ❑ Private Depth To Water Tables ft. Character of soil to a depth of 3 feet: Sand Gravel n S ndy Loam`❑ Clay Loam eclay ❑ Adobe❑ Hardpan i Previous Application Made: (If yes,date____________________) No New Construction: Yes @ErNo ❑ FHANA: Yes ❑ No -TYPE OF INSTALLATION AND SPECIFICATIONS:" (No septic tank or cesspool permitted if publicsewer is available within 200 feet.} a /: Distance n cam arteares__.__�-----------_Distance,.from foundation--------.`_....Material-_______�.................................. Septic an Disfiance ropm nearest we --- ' Size------- --#----.-,---Liquid depth---------` :------._Capacity------ Disposal Field: Distance from nearest well._02�__._Distance from foundation..__10_______-Distance to nearest lot line__zS77_._-_ - it (�'T/At(,� Number of lines......_._..__ _ t ---- Length of each.line_.___7 _______________Width of trench------ o'c;; �`. ,, f ------------- „� �p� Type of filter materiaL_j3_______T •_Depth of filter material______�Q________Total length___________�p_____________________ Seepage Pit: Distance to nearest well---------- =__:'_-:_._Distance from foundation----------A.......Distance to nearest lot line________________- El Number of pits----------------------Lining material--.--------------------Size: Diameter------------------------Depth--------------------.--_--------- Cesspool: Distance from nearest well_________________Distance from foundation---------------____.Lining material__._______________..________________ Size: Diameter------ -----------------------------•-Depth----------------------------------------------------Liquid Capacity----------------------------gals. Priv Distance from nearest well-_-_______________--_________________ _______Distance from nearest building ---------------- N . ❑ Distance to nearest lot line------------------------------------------------------------------------------.... •-------•-•-----•----•------------------------------------- A 1~ Remodeling and/or repairing (describe):- ' •--••---•------•-•-•------••------------------•--....._. ----------------------------------------------------------------------------------------------------------- --- .---.._.---••--•--•-•-------•-•--------•-•-:-------------------.._..------------------------------------- i 3 ------------------------------------- --------•------------ --•------------------------ -••-•---------..------------------------------ -------.........---- '.1------------------------•-•--------------------------------- I hereby ce ify that I have_prepared this application and that the work will be done iri'accordance with San Joaquin County ordinances, laws, and rund regulations of the San Joaquin Local Health District.1 (Signed �- ---- ,.-Q ------------ --------------------- - -------------Owner and/or Contractor BY:------------------ ---------------------------------------------------- ----------------------------------------(Title)--....-------------------------- ------------ - --- ------------ (Piot plan, showing size of lot, location of system in 'relation to wells, buildings, etc., can be`placed on reverse side). t � r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.---- ' `- ----------------------------------------------- DAT E------1�=--- --- = ----------- A c - --------- -------- ------------- DATE------------------ --..-----"----------------------------- \ BUILDING PERMIT ISSUED = ------------------- -------____...........--------__ A�T ......... Alferations and/or recommend'ations__________________'.......-____._ t I °°" -------- ----- •- ------ ---------------------------------------------------------- I .. ------ ------•----------------- ----------. ------------------------------------- ------------•----•-•-------•- ---r _________________________________ j i i __________________________________________________ __ _____ _ __________________ ____ ____ ------- ------------------------------------......... _--.-______-..____-_..____.-__._.____---__-_.-_-__.__.---_- FINAL INSPEC BY- . ---- - ---- ._ da 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 (� E5 9 REVISED 8-59 2M 5-62 ATLAS