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FOR OFFICE USE: �� . Iry ------ ------------------------------- __------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. f . _.. i -- -------------------------------------------- --------- (Complete in Duplicate) 1 Date issued ...........f.. --'---------------------------'- ------"----'---'- -- I This Permit Expires 1 Year From Date Issued . I 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,=544�9�./,- 'r. j� JOB ADDRESS AND CATION_ 1-p _ Li� '�V�I---- 1 Lt. t .. _.. s y.•- _ _... Owner'siName--------- '} - Phone._-- --------- ----•-•---••------------ pg Addressr....... --� Zr-'-------------so!------. �/ -11W1je__*1------------�=0DI----- '... r."� ............. . . Contractor's Name -..:1 Installat�o n will serve: Residence Apartment House ❑ Commercial ❑ Trailer% � f Motel E] Other ❑ Number of living units: __ __ . i �. . Number of bedrooms •�_-. Number of baths 1_----tLot`slze _.__..t�C:-�i.��}.�T�.................. Water Supply: Public system ❑ Community system ❑ Private ReDepth To Wafer Table .55—ft. s II s Character of soil to a depth of 3 feet: Sand Gravel El Sandy Loam El Clay Loam❑.IC]e,y E] adobe E] Hardpan ❑ Previous Application Made: (if yes,date----------------_--) No A�New Construction: Ye g?','No Q FH /VA: Yes el"No ❑ ;t TYPE OF INSTALLATION AND SPECIFICATIONS: so (No septic tank'o�ee'spool permitted if public sewer is available within 200 feet.) 3� Septic,Tank- Distance from nearest well---Sa___- Distance from founclation__ Q--._-----.M1ternal---I7-e;Dky®VP----------. 1No. of compartments_-.-_.._ -----------Size-s ..aL_� _X—_-Liquid"depth- }' ' f .s !capacity.... l Disposal Field: Distance from nearest well---,,�.._-.-----Distance from foundation.- P` ce to nearest lot Gne._>, .........� Number of lines......- _--- 27 -- -" Wi'dth of trench.-...-3�__��.-.I-- --------------------Length of each line-------.----_ -_-- ----- Type of filter material__.__ 0.G�_-Depth of filter material__-----� �.....Total length..•..........-------- 7�--•--_.-- t - Seepage Pit: Distance to nearest well----------------------Distance from foundation.............-------Distance to nearest lot line------_�----_---- N .of pits Lining material Size: Diametery"'M..---D�Pth--------------------�` Cess;ool:" """ ' Distance from nearest well from foundation------------------- Lining'materiel-------------------------- I-.--_----- Size: Diameter---------------------------------------De th----.------------ --(Li wd .Capacity ❑ p -------------------------------- q �� ...............-..-•----�-•gals. Privy: Distance.from nearest well------------------------------------------------- from nearesIbuilding-------------------------..___' ------.-.. ❑ Distance to nearest lot line------------------- -------------F_ - I' --- •----------•-------------------- Remodeling and/or repairing (describe}______________ ........... -------------------•----•-•-----•------•--------------- ---------------------------------------=--•---•---•-----•---------------....-•--------•-------•-----------•----------------------------------- -••----•-•------- '� rr ............... �__--- ""'-IF--------•i-------' -1 Y ----------------- ------ ��? _,i� - ----------- ----------------------------------------------------------------- -------------------------------- I hereby certify that I have prepared this application and'that the work will be done in`accordance with San Joaquin County ordinances, St #e laws, rules nd egul ions of the San`;Joaquin Local Health'District.' ` N (Signed) •---.... .1�1 ru/les ----- ---- ---- (Owner and/or Contractorl C . u By:. -- (rtle) .-_.: rte : ' (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). is p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY t R `©-`----------------------------------------------------------------. DATE.-------.. -.'"'ZF76---------- REVIEWEDBY.-- -------------------------------------------------------------------------------- DATE------------------------------------------ ---------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- - DATE----------------------------------------•---------I'---------- Alteretions`and/or' recomme,_}f}y�atton :-"-�'}�_. k/J�y,'- - iI _- ------------------------------------_-._...-.-.------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ... . ....... . .. ------------------------------- I FINAL INSPECTION BY:-------- --------------- Date----------- .. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS 4.&