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FOR OF l E U E: x ----- -- �-��-- - - 3VL- - APPLICATION. FOI SANITATION PERMIT Permit No. %��.. � ------------------------------------------- ------- --- (Complete in Duplicate) Date Issued .... -------------------------------------------------- --- I This Permit Expires 1 Year From 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 A D OCATION = ---------- .------- .--•. ..... ........................9.1 .......--------------------- Owner's Name-----Wit---_Ltf l t - Phone- ---R-Q..l . Address._ ._..---•.........--•--•-••------• ----------- -------- ---------- � r // J Contractor's Name-------------- Er..._.._ PhoneN .�P..� !v Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1.__- Number of bedrooms! -__- Number of baths __/__ Lot size ... .......................... i 9P ft. Water Supply: Public system ❑ Community, ❑ Private Depth To Water Table `� ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San y Loam ❑ Clay Loam ❑ Clay ❑ Adobe�( Hardpan ❑ Previous Application Made: {If yes,date___________________J Na ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ .7{_ t TYPE OF INSTALLATION AND SPECIFICATIONS: ; o septic tank or cesspool permitted if public sewer is available within 200 feet.)' " ,t; r Distance from nearest well_________________Distance from foundation................ Material______.._______________.__.._---..___.-..__.__--- k 0 U No. of compartments--------------- ------ Size...........--------------------Liquid deP.ah-------------=------------Capacity--------------------- t Distance from nearest well �--�-_Distance from foundation.._! .0--_____-Distance to nearest_ lo`li�. U Numberlof lines--------- _ _____ _ Length of each line_______FO-_________�r__.Width of trench.___ .�.._._gg�� Type oflfilter materiaL,S� .Depth of filter material_______ ____-_.Total length-------------•-•----•----l�_s _... Seepage Pit: Distance to nearest,well-----------------------Distance from foundation--------------------Distance'to nearest lot line-___.__-.:_..._.. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.....................%.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 (descri e):�7 `�° ____v y ------- ------- ------ 0 �__�--r---.�---- -------:....... � b ------------- - .--•--•. ---- - -- - � . ---------------------.- ._.5� _�-- ---;-------- = J - #�- 1 here c ,fy that I have prepared this application and that thh work will be done in accordance with San Joaquin County ordinances, a# laws,anide rules and regulations of the San Joaquin Local Health District. (Signed)___ r - ( ner and/or Contractor) . ------ i By:-----------------------------------= -- - -- -- -------- --- - ___(Title).. 4; F -- id -------- (Plot plan, showing size of lot, location of syst m in relation to wells,. uildin , etc.; can�be placed on everse side). FOR DEPARTMENT USE ONLY' APPLICATION ACCEPTED BY--------- 'cr✓------------------------------------------------------------ DATE--------+Ca__� �a_3----------------------- REVIEWEDBY---------------------------- --------•---•-----------•------•---..... DATE-------•---------------------------•------------------------ R BUILDINGPERMIT ISSUED--------------•----------------------------------------------—----------------------------------•--- DATE-------------------------------------------------------------- Altera+ions and/or recommendations:---------------- ------------------------- - - -----------------------------------------------------------••----.......------------------------------------- - - - -- FINAL INSPECTION BY:------- "':....- .�cd-.....................--------------- Date------j6".=..5!Z a-- -3 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 r E5 9 REVISED 8-59 2M 5-62 ATLAS _