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FOR OF US 2. /�J' G ;? --- ------------ --------------------- ~_ . - APPLICATION FOR SANITATION PERMIT Permit No. .../ _s-..s .� ------------------------------------- --------------- (Complete in Duplicate) --- ----------------------------------------------------- This Permit Expires 1 Year From Date Issued `"1 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 is made in compliance with County Ordinance-No. 549. JOB ADDRESS AND LOCATION---W.9------j..�4� "_'------•-----------------------------------------•------•--•--------------------••------••-•--••-------- Owner's Name__........ �1►*._...�� --------------------------------------------- Phone.................................... Address.......... 2.3.._1'&. :_Q4-f1-------•----------------------------•------•--•---------•--.......----------------------------•---------....----••------....------•-------.....---------........ Contractor's Name....� ds.7,;-.........--• •-•---...•-- Phone................................... Installation will serve: Residence Q"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1...... Number of bedrooms _3___ Number of baths .1..... Lot size ...�rJrx---Ar Water Supply: Public system Community system ❑ Private E] Depth to Water Table _l P_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobefn�'Hardpan Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes PT""No ❑ FHA/VA: Yes ❑ No LL}� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septink: Distance from nearest wgjl:_�_..— Distance from foundation_/Q.............MateriaJ___� � .. ........ ;e No. of compartments-___--'z•----.......------Size_`! .�._?_c---_----,__-Liquid depth_.. 's$ �_.,__-__-__Capacity...Zee 4 Disposal Field: Distance from nearest well-----------------Distance from foundation.-------------Distance to nearest lot line......... 09", Number of lines_____________________________ g � . Length of each line______________________________Width of trench....a't.y.................._ Type of filter material._.�_I__D.C`-k..-_Depth of filter material__:/_9__"__________Total length__._._...f�l•�..................... �. Seepage Pit: Distance to nearest well---- from foundation__A.i•_.•...•_..Distance to nearest lot line_..._..... � Number of pits...�---------Lining material`Rot,(-------Size: Diameter....3A.-._.......Depth.........a rc ................ Cesspool: Distance.from nearest well.................Distance from foundation--------------------Lining material..................................... ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well________________________________________________Distance from nearest building.......................................... ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodefingand/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 reg lations of the San Joaquin Local Health District. (Signed)..................................................... .-•-- -- ----- ------------------------------------------------------------------------------(Owner and/or Contractor) By:................................. •..... . -- ---------- --.........................................................(riifle)---------------------------------------------- -- ------------- (Plot plan, showing size of lot, ton o system in relation to wells, buildings,etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 10 APPLICATION ACCEPTED BY--- - ------------------•---••---•--•--•----- DATE_._, .................. REVIEWEDBY............................-•--- ----------•--• DATE............................................................ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------.............. DATE.......................................................---- Alterations and/or recommed'ations---------------- -------- -- ------------•----------------------------------------------------------- ------.-_--.---------------------------------------------------------------•-•-•••-•--• •-----••-•----•------•----•--- FINAL INSPECTION BY:..- Date ..- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stmet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-61 ATLAS T