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FOR OFFI --j- ------ - `� I z-_-- --- APPLICATION FOR SANITATION PERMIT Permit No. ...rf.`f . .% --- ----------------------------------- -- (Complete in Duplicate) Date Issued _ ----------------------- This Permit Expires 1 Year From Date Issued .__.._.. ......_..... Application is hereby made to the San Joajquin Local Health District for a permit to construct and install the work herein described. This application de i compliance lth County Ordinance No. . JOB ADDRESS ANTI �------- ------- �!l�. .._....--- Owner's Name ., �/j - �1.. - j, _r. L '-------------------------------------------------------- Phone.................................... Address 7.-------- -----•-- -- Contractor's Name-- 4a ------•--- -----------------------------------------------•---------•-•----•----•--- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑' Other Number of living units: ._l__. ber of bed -- �F?. rooms- -- Number of baths /.__ Lot size .... .1 �t � .............. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablelyd. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No BF--lNew Construction: Yes ❑ No 2--�FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well..__""-------Distance from foundation__�.LS-_1--------mat grial___0-_<`..... �....... No. of compartments-___---)---------------Size....i _--Liquid depth__'..1{/-------------Capacity... ......... Disposal Meld: Distance from nearest well--'-----Distance from foundation...)U ........Distance to nearest lot line--5........... Number of lines--------- Length of each line.....-..__3:fn.............Width of trench . .................. Type of filter material.. L_ (-0<,k"_._Depth of filter material____ Total length........ ...................... Seepage • Distance to nearest well------------------------Distance from foundation...jC...........Distance to nearest lot line...4..,....... 931, Number of pits...-_-_-.- -----Lining material__ �_X�_-__-Size: Diameter------ .-a_4 .._.Depth.- ............... 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----------------- ----------------------------------------------•----...----------------------------------------------•------•--•----•-.------ Remodeling and/or repairing (describe):------------ t --------= '� ' ----------`a.`� ------------------------••--- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------••-----------------------------------•-----------•----------•--------•-------••----------------••----------------------------•-----------------------•--•-----------------.....-------••-------------------------- --•---•...•----•----------•-------------------------------------•---------------------•---•------------------------------.--------------•---------------•--•-------•---•-----------------•---•---•---------------•----------- 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 regulations of the San Joaquin Local Health District. (Signed)------------------- ----- ------ 'k � ~�_= - '' {1 �.' �t,_('!C� -- ---a=...�ry----.(Owner and/or Contractor) By:.... `�Z '-� =� � =--------- -----------(Title).........(1_' `'_:k1_C fid.......................... (Plot plan, showing size of t, cation of system in relation to wells, build �tc., can be placed on reverse side). F91 DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..,.- )------_�____ __ _____________--"`` DATE '�� REVIEWEDBY-------------------------------------- ----------------------------------------------------------•.. DATE.................................................. PERMITISSUED---------....................................................—...................................... DATE............................................................. Alterations and commendations: _ -•------------ ----••------------- -`1`? �...�--�j��- �`-• �\�-�---- =��'--�_=--�="�--•�t_._ -----��i-��-cam.. �•�-�.�'�L-...�.....,��,..---•-----`"7----� , ............................. -------------------------------------- ----------- .......................... FINAL INSPECTION BY:_u`C ---- -/ t'=' Date...... -__.�.f�T--- SANJOAQUIN 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 8-59 2M 5-61 ATLAS