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FOR OFFICE USE: --------------------------------------------------------- � ---------------------_.---_.----------------------_----- APPLICATION FOR SANITATION PERMIT Permit No. ... �1p�J_. ,, ------------------ --------------------- ------------- (Complete in Duplicate) ,��1, / This Permit Expires 1 Year From Date Issued Qete Issued•• -_'_- tl..� 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 LOCATION./V- A- . ,[� -. k + Owner's Nam _-.._ _.. ---- �.Q�i,1it.. ----- -- - Phone.--•'------------- 4 fZ4—t' gs-.3 f Address ----------------------------------- ................ -----------------------•----- G� 6 Contractor's Name---------------- - Q' 4r Phone................-------•---------- Installation will serve: Residence E] Apartment House E] Commercial E] Trailer. 115ft, otel [I Other ID Number of living units: Number of bedrooms I----- Number f baths _�---- Lot size .......,�a_['�a1------ --- ----- --- - -- Water Supply: Public system ❑ Community system ❑ Private F1 Depth TO Water Table 10-- ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan G Previous Application Made: (If yes,date---------_----------) No EQ New Construction: Yes fZ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well �rQ.--�-_Distance from foundation_-.1'P----..---.Materl---91014.---- No. - _ ---- ------------------------------- No. of compartments-----'�--------------Size4_wA1x_.!Ptx-�r Liquid depth------- -_------.__Capacity_JZ4_0-- P �G ' Dis o l Field: Distance from nearest well...-%2,1 Distance from foundation..............._..Distance to nearest lot line._,--.-_---•-•. Number of lines----------------I'----------------.-Length of each line------- ----------Width of trench......;Z�----_--------_-__----- i Type of filter material.__,, r._ h of filter material__-_-- Depth -----------Total length•----�� .-_-De l �. '� / ' � ----------- Seep a Pit: Distance to nearest well. _a..-I� --.---___Distance `fro"m� found ation__-.1.:�_�..._..Distan a to nearest lot line..,. Number of'pits--: ----------- -----ILining material_-!_L�,r----.Size: Diameter------ -_... Dept / ' P r ------------------ i Cesspool, Distance from nearest well-=---------------Distance from foundation--..-_-.----------.Lining material------------------------------------- ❑ Size: Diameter-------------------'•---------3---....-D.epth.-•----•---------------------:----------------------Liquid Capacity gals. 'A-- J Privy: Distance from nearest well .-Distance from nearest building--------_-.-_---------_--_-_-----------.-. ❑ Distance to nearest lot line`---------------------------------------------- --------------------•-------------- Remodeling and/or repairing (describe):;----------'-----------------------------------t-------.-..-------------------------------------------------------- --------------------------------------- ---------------------------------------•--- ---------------------------•-•-------•------------•-- ---- ----------------••--•-•-------•-----------•-------------- -- ti a ---== --------------------•---------------------------------------•-----------••- ----------------------••-•-------------- I herebyLifyat I have prepared this applica+ion and that the work will be{done in accordance with San Joaquin County ordinances, S and les and regul tions of th San"tiloaquin Local Health Distric+. (Signed)_._._ l c """'fir,and/or Contractor) By---• - -----------(Title)-----------•-------- ------ ..-....... �.--------- - ------------ •------------- (Plot plan, showing size of lot, location of sys+em in relati n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -------------------------------------------•----------- DATE--- ------------------- REVIEWEDBY------------------------ -----•---------------------------------------------------------------------------------------------- DATE-------------------------------- BUILDING •PERMIT ISSUED...--•----------------------------- ------------------------- DATE..- - ---------------------------------•---- ----------•-•--------- Alferationsand/or recommendations:----------------------------------- ---------- -----------------•-------------------••----•-••--------•--------••---------•---...._..------------------•------ =' ".._ -- -----------------------------------------------•------. ---- - ----- ------- --�`�7----- - ----------•----••----------------------------------•-------------- ---------- -----------------------------------•----------- 1� • �Z -----------------•-------------------------------- ----------•-------------- •---------- BY FINAL INSPECTION ------ -- ----- --- - 'p2 6 ! Date--' •--- + SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 724 Sycamore Street 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-52 ATLAS Y t