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FOR O ICE USE: ------------------ ----- ---------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. .. ,1__..... -- ---------------------- ------------------------------ (Complete in Duplicate) Date Issued 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. ( _ .. ._. y JOB ADDRESS AND LOCATION: 4U. - -� 1 � - -`•� ��``.....--=t > Phone..._.._ 4 J � u t.v....l �t-lJ Owner's ---•- � �'3r....__.... _ �►1✓ ---------------------------- Name Address-•--..-•--• - ..... Contractor's Name__-___ �-----------------------------• •----- - Phone---......--------------------•- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ___ ___ Number of bedrooms ----- Number of baths ___f___ Lot size ----J_p _Ok4 ------------ .......... Water Supply: Public system ❑ Community system ❑ Private [Depth TO Water Table _75. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loarlay Loam ❑ Clay 5 Adobe❑ Hardpanf Previous Application Made: (If yes,date____________________) No ® New Construction: Yes IM No ❑ FHA/VA:.Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ Septicank: Distance from nearest well__--4*A-----Distance from fQundatjon__J_I¢_----------Material.....+'�'��'��-�� C� No. of compartments______"�_-________.__ depth_______ Caaci__________ __ p ty._I.__t_b�_ .. / Dispos Field: Distance from nearest well----��_---Distance from foundation___.l____d__/ .___`_______D15#ante #o nearest lot line_• ____...... Number of lines------------------------- Length of each line------ d_/-_.---__-_---Width of trench-----2_-�-j_____•-•--•---____-- Type of filter material._. --_Depth of filter material_____1,?__ --------Total length :-Jta)_________________________ f w .,,r 01 Seepa Pit: Distance to nearest well___J.C�_._______Distance from f undation__.'J. ___.•.._..Distance to nearest,lot line..._.______.. 33-f � . 2 Number'of-pits-------/-------------Lirfing material. . . _ __.Size: Diameter---`-----_-•-.-..-__-Depth--- .- =----....-------____-- S - r Cesspool: Distance from nearest well---------________Distance.from foundation--------------------Lining material-------------------------_......... [] Size: Diameter------'i----------------------- Depth---------------------------•------------------------Liquid Capacity..._......-----------------gals. ` Privy: Distance from nearest well----------�..__.�_ _--____-i.__=._-1___Distance from nearest building____________ ________________________ ❑ Disfance to nearest lot line---------------------------------------------------------------------•--•--_--•--------------------•---------------.-..-------------------- i Remodelingand/or repairing (describ!�:----------------------------------- ----------------------------.-.._--------------------------- -------------------------------------------------------- --------------------•-- --------------- ----------------------------- ... ` .--------------- e4 .._ __ _____ ___________ ---___._-^m___-__--. -___________________.__._._____.___________________.._.____________.....______._________._______.__.--------------------------------------------------- I hereby certify`-that•Nw,,re prepared +his 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) 34 ____ and/or Contractor) BY� - ---------- C3 (Title)__ - (Plot plan, showing size of lot, location of system i `rely ion + alis, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__._Z,0411._ !---------------------------------------- DATE--------__-.`-_---_`-0'_____________________.__.. REVIEWEDBY-------------------------- -----------------------------------------------------------------------------------------•----._.. DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE...=-_------------------------------------------------------ Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- -------•-----•-•-•-------•----•---------------------•----.-.-_- -------------------- -•-•----.-------------- ---------------------•---- --. -------------•-- ------------•-•--------- -----------------J . -------------------------------- --------------------------- --------------------------------------------------- --- -----------------•------------------------------------••-----------------------------•-. /f` Date_ .. -`-`!Ln -�.e----- FINAL INSPECTION BY:___.4�'�.-10----- ------�- -- ---- ' 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 Trocy,California E5 9 REVISED 8-59 2M 5-62 ATLAS