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FOR OFFICE USE: Permit No. _l.* I -------------- 4- APPLICATION FOR SANITATION PERMIT ---------------- (Complete in Duplicate) Date issued ._ A.._..._...__-_-• -- --- This Permit Expires l Year From Date Issued f 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 Qrclinance No. 549. L` ------------•-----------------------•-•-----•--------•-•------•-------- JOB ADDRESS AND LOCATION___-.•-7- /-----------------C --Q---------.------•- + --------------- - Phone.---••------••------••-------------- Owner's ----•----•--- Owner s Address-------------- ------- .-- -----•-------------------•------•-----------•------•--------•---_... Contrac#or's Name.._-. -----------•------"•--•------------------------• • ...-.. .._..._._. ----------------------------•--•-- Installation will serve: Residence {��Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -.4-.-- Number of bedrooms _4--_ Number of baths _C..__ Lot size ..._. _x rf - - a e ❑ Private Depth To Water Table -------- Water SuPPi • Public system �CommunitY s stf+. s Character of soil to a depth of 3 feet: Sand El Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay C3 Adobe Hardpan C1 'ote-___---"._______-__-) No New Construction: Yes eNo ❑ FHA/VA: Yes ❑ No 0-� Previous Application Made: (If yes,d I TYPE OF INSTALLATION AND SPECIFICATIONS: fi (No septic tank or cesspool permitted if public sewer is available within 200 feet.) IMater'ial.--------•------------------••-.•-•------------- 5ept' nk- � Distance from nearest well-----------------Distance from foundation-------------------- P ty �/ No. of compartments------------ ------------Size--------------------------------Liquid depth--------------------------Ca aci Dispose field: Distance from nearest well-----------------Distance from foundation--�ia�__.--------Distance to nearest lot line..-3.__..-.-_-. r Number of lines_______ _ __________.-__-__- -Length of each lin slat_ d- --------------Width of trench.-___AJX------------------- Number of filter material.__�A,_a L---Depth of filfie material----l.R" -------Total length------- 0-_---------------------- Q Seepage Pit; Distance to nearest welL_� --.---_--Distan m ou dation-10 to nearest lot lined-----_--.. ----- ----.Size: Diameter- 3 •------.----Depth---------1_ Number of pits--i-_-- ------------- materia-- ".--_lining material ------•--•--------•---------•-- Cesspool: Distance from nearest well-----------------Distan�-fro oundation-------------- Liquid Capacity----------------------------gals. Size: Diameter-------------------------------------Depth-_------------------------------------------------ q P tY------------ - ' _Distance from nearest building-------------------------- O Privy: Distance from nearest well--------------------------------- ------------- ❑ Distance to nearest lot line--------------------------------------- ---------""--------•---•--------------------••------ Or --•------••-------•-----•----------------- Remodeling and/or repairing (describe :_---__--_------_-_--- ------------------ ----------------------------------------------------•------ ----•- ---------------------- •---•-------••-------• --•------------------------------------ --------------------- ------------------------------ ----------_her--------ere- ------ - -- - .r •---------------------------------------------•--•-----------------------•---------------------- I hereby certify that I have prepared this appli tion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations he an Joa uin Local Health District. ' (Owner and/or Contractor) (Si ned g -- ------•-------- --- ---- -------------- rtie (Plot pion, showing sire of lot, loco+Ion o sys rela+ion #o elis, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i, DATE f 1 --. ------------ APPLICATION -----� - ----- ----------------------------------- ----------•--- APPLICATION ACCEPTED B-- ----- ------ --------------------- - ------------- DATE------------------------------------------------------------ -------BY. DATE--------------••- ------•--- ------------------------ -- BUILDING PERMIT lS5UED_... ------------- Alterations and/or recommendations:------/.- --------- -------------------------------------------------------------------•-------------- --------'•------- ---•--•-------------------------- -------------- -- - --- Date------ -----1 - -------------------------- ..--. FINAL INSPECTION BY:...- .--- ----------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 305 west 9th Street IManteca,California Tracy,California Stockton,confornia Lodi,California j E5 9 REVISER 8.59 2M 5-62 ATLAS -