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FOR OFF cE yJSE: 17csti '3 ------------------------ APPLICATION FOR SANITATION PERMIT Permit No. __ h -----• (Complete in Duplicate) 1 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 application4ade in compliance with County Ordinance No. 549. JO ADDRESS AND LOCATION-------- 1c_--` ---------r�,�C :3.7-------------------�S�Tf��/---------C---•_.. 16.. .....41- -- ----------_..---- Owner's Name------.y_2.&—W_F........ 7w ----- - --------------------------------- --- Phone l � Address-------------------------------- `S �l Contractor's Name....... .: :..l�l�/�ii�/_tS _ s�f�l�sS---- --------------------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms _�?_ Number of baths __2rLot size ...._4P—_-� eV_ ______________________ Water Supply: Public system ❑ Community system ❑ Private [El' Depth To Water Table _6 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe E Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 2"—New Construction: Yes ❑ No E]' FHA/VA: Yes ❑ NoJT� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundation____..._..__.______.Material------------------------------------------------- ❑ jNo. of compartments--------------------------Size---------_------•-----------_._Liquid depth-----------------------.-Capacity----------------------- Disposal Fiel Distance from nearest well----- Distance from foundation..... Ar— .__.Distance to nearest lot line...' �.. [ Number of lines----------- ----------------------Length of each line-------L:F-O--!-----------.Width of trench----------- Type of filter materiaLR,0e_K-----_--Depth of filter material..._.__,)._____.Total length______________ev-------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line................. ❑ Number of pits----------------------Lining material-----------------------Size. Diameter-----------------------Depth--.----.--.-.---------------.---- �ro Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material-.---_--____-_-_____---_--__-___-___- ^t ❑ Size: Diameter--------------------------------------Depth_........------------ ...........................Liquid Capacity............................gals. 1_ Privy: Distance from nearest well_________________________________________ _______Distance from nearest building_________-.------_-_---------------._____- ❑ Distance to nearest lot line--- ---------------------------------------------------------------------------------------------------•---------------------------------- Remodeling and/or repairing (describe):--------1 ,L2d----,tea-----.eA2_5 e'A-G ----- ---------------------•-_------------------------- -----------------------------------------------------------•-------------------------------•-•---•----------------------------------------------------------------------------•---------------------------------------------- hereby certify that I have prepared this 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)............ :_-- ----------- -- --- - ct�-r..�J--_--- -'---------------------------------(Owner and/or Contractor) By:...------- c��_.�� --------------- ---------------------------------- -----(Title)----------SCJ--e---------------------- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- DATE 1 �// REVIEWEDBY--------------------------__--- ---------- ---------------------------------------------------------- --------------------------------------------------------- DATE---------------------•--------------------- BUILDINGPERMIT ISSUED------------- •----. ------...__---•-------...--------------•--------------------------------------- DA-TE-------------------------------------------- Alterationsand/or recommendations:------------------ ---------- --------------------••-•-----....----.-...----•--•---------------•---••--------•--------------••-•-------------------------- -------------------------------••--------•-----------•---•--------------------------------------------------------------------------------------•----------------•-•------------•-----------------------------------••-- -----------------------•-------------------------- ---•--------------------------- --------------------------------- --------------------- --------------------------------------•••------------------ FINAL INSPECTION BY:...�'�_..�_*_--- ------------- Date------------�'- f-----.-- SAN JOAQUIN LOCAL HEALTH DISTRICT 4 130 South American Street 300 West Oak Ser"1 124 Sycamore Street 205 West 91h Street Stockton,California Ladi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS