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FOR OFFICE USE: ------------------------------------------ ----------- l S-a a --------------------------------------------------------- APPLICATION FOR-SANITATION PERMIT Permit No. ... .•._._----_. ----// ------------- ------------------------- ----------------- (Complete in Duplicate) � 1 -------------- This Permit Expires 1 Year From Date Issued Date Issued ________ .._._.__ 6 7/'. 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. S49. JOB ADDRESS AND OCATION------`�� _... + ---------- ----------_------- i Owners Name-------- !E---•-- ------------------------------------ -------------------------- - - ----------------------------- Phone---------------------------------- Address------------------------------- -------- ---------.-._.._.--_ ............. /�- ...................... Contractor's Name. -----. ._ �{✓ /1 --• 11�F L�------- �f�'r° P�erfe Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- J----- Number of bedrooms __3--- Number of baths A' Lot size __�_�_'�'_f.r�t�___•____...-_................. Water Supply: Public system V? Community system ❑ Private ❑ Depth To Water Table 47 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam W Clay Loam ❑ Clay ❑ Adobe,® Hardpan ❑ Previous Application Made: (If yes,date--------------------) No E? New Construction: Yes W1 No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept Ta, k: Distance from nearest well_________________Distance from foundation____- -----------Material....__._.--_--.-__-__-_._._._.....___.__________- No. of compartments---- ----------------r_Size---•-•--------••------------=---Liquid depth--------------------------Capacity---------------- LA - isposal Field: Distance from nearest well---ir.61....Distance from foundation-.-n_f_____.__Distance to nearest lot line.4_. ,� Number of lines-----1_______________ ___ __ Length of each line------ _ d_-------------Width of trench----____�{____._____.-__.____.._ Type of filter materia Depth of filter material---I " __-__Total length__— ...............------------ Seepage ........... See a e Pit: Distance to nearest wet _ _--_____________Distance from foundation___'.:.........___.Distance to nearest lot line-----------------P g O ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------•---------- Dept h---------.---------.------------. Cesspool: Distance from nearest well---------------- Distance from foundation-__-______.______-Lin ing material_.--------..___-____________-__-.-.-- Size: Diameter--------------------- ------------De th--------------------------------------Y-----------Li uid Ca aci ❑ ----- P � _- - q P tY------------------------••--gals. Privy: Distance from nearest well.____.___._._.__--__"___.___________ _______Distance from nearest building------------------------- 11 Distance to nearest lot line-- --- -- ----------------------------------------------------------_---------------------------------------------------------------------- Remodeling and/or repairing (describe)--------------------------------------------------------------------------------------------------•----------------------------•------------------------ ---._...--•--••------------------------•-•-----••------------•-------------------•------------------------------------------------- --------...---------------------------------------------------------------------------- ------------------------------------------------------------•-•-----------------------•---•---•-----•----------------------------•----------•---------------------------------------------•-------------------------•------- --------•------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ 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 ands�y}regulationsofthe San Joaquin Local Health District. (Signed 0_1 l�rl` ----------J5.t------- -----------------•- --------------------- (Owner and/or Contractor By:------ Einl - < �r ---------Ertle)--------- ----------------------------- ---------- --------- (Plot -- ---------- (Plot plan, showings ot, location of system in relation to wells, buildings a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----. -- DATE-/.;--'• '-•-- —--------------------------- REVIEWED BY----------------------------------------•--- ---------------------------------------------------------------------- . .... DATE------------------------ .. _ ----------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------- --------------------------------------- --------------- DATE------------------------------------------------------------- Alterafions and/or recommendations:------ --------- --------------------------- ----------------------------•---------------••---------------•--------------•-----------•------------------ ---------------------------•-•--------------------------.---------------.-------------------------------------•-------....-------------------•---.---•------------•----------•---•-•------...... —----------...------------- ---------- ---------------- ----------.---------- ------ -------- - f-,-------- •------------•�-------- ----------------•--------------------------------------- FINAL INSPECTION BY:.... /•9- ------- Date.- �---------- ----------------------------- SAN - - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wert 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ` ES 9 REVISED 9-59 2M S-62 ATLAS }