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FOR OFFICE US[=: # �11 3 S/T .� / r -- — r ------------------ r___.___.___.__.__._...__---_ APPLICATION FOR SANITATION PERMIT Permit No. .. ...:...."s..."�.. --------------------------- ----------------------------- (Complete in Duplicate) Ft�� ----------- -- This Permit Expires 1 Year From Date Issued Date Issued -_______ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thai'iapplication is made in compliance with County Ordinance No. 549. if�l�-t Es•I �� -•, JOB ADDRESS AND LOCATION............. � ° �� ► °__ -...�a 1` ,��II t Owner's Name----------------J9..... Address. 7 4#Q•A------I 43-------------------------------------------- - - ------- Contractors Name........ _L.. -----•....................................... Installation will serve: Residence I2 Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: ___/___ Number of bedroomfi s___ Number of baths ___i__ Lot size ...._._.._7-�Z.___ _________________ Water Supply: Public system ❑ Community system ❑ Private [-Depth To Water Table _2_a ft. Character of soil to a depth of 3 fee+: Sand JK['' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--- &/-.) No ❑ New Construction: YeS,A`No �j FHA/VA: Yes ❑ No EX TYPE OF INSTALLATION AND SPECIFICAT ONS: (No septic tank or cesspool permi++ed if public sewer is available within 200 feet.) p Septic Tank: Distance from nearest well_____ _Distance from foundation---`__..........Material----F02—__`.-,v __--------------- No. of compartments_,-------_,1 -----------Size..._ �Y."%C___9 -'Liquid depth------Y r_____________Capacity_./A!�.`-' e... Disposal Field: Distance from nearest well___j7_P---.-Distance from foundation-___.f P___.......Distance to nearest lot line.__I.......... Number of lines---------------3-----------------Length of each line_-_7!p_'_4A�r6Q*'_.Width of french-------Z__`_______________--- Type of filter material----XP<__,_-___Depth of filter material___1 ____------._Total length__________1L-_0_____________________ Seepage Pit: Distance to nearest well---------------------- from foundation____-_-_-___--•_..-.Distance to nearest lot line__-________-__--_ ❑ Number of pits______________________Lining material-----------------------Size: Diameter----..............____.Depth---------.-_._._-____---________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____._____-.___________---•_-________ ❑ Size: Diameter-- I---------------------------------Depth.------------------..•-------------------:----------Liquid Capacity------------------_--_--gals, Privy: Distance from nearest well-____________________________________.._ -----.-Distance from nearest building-----------------------.......-..-..__._- ❑ Distance to nearest lot line--------------------------------------y----- ----------------_- Remodeling ---------------_Remodeling and/or repairing (describe):- AL-4:.1. --1----- '` ' .. .....---• ... -----------;,.�, �� .. ,.— ----------- -- -- -- - ------------ - -------............... --------------= --- -•--------------- --------------------------------------------------------------1----------------------------------------------------------------------------------------------------------------------------• ----------------------------- I 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 re ulations of the San Joaquin Local Health District. l (5i ned •- '- g } -------- --------- i - --- ---------------------------------------------------------------------.(Owner and/or Contractor) By:------------------ ---•r------------------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). _ ( ( FOR PARTMENT USE ONLY APPLICATION ACCEPTED BY------ ----------- -------------------------------------- DATE---- - -------------------------------- REVIEWED --- :----•---- ------ REVIEWEDBY---------------------_--------- ------------------------------- ------------------------------------------------------ ---- DATE-----------•------------------------------- BUILDING PERMIT ISSUED---------------------------------- ..... DATE------------------------------------------------------------- Alterations and/or recommendations:------------------ -------------------------- ................---------------------------------------------------------------------- ---------------_-----.-. ---•---------•------------------ -----------------•------------- ------------------------ --------------------------------------..-------------------------------------------------------••--•---------------- FINAL INSPECTION BY---------- -- -- - --- ------------ - ---------------- --- Date_-- ---------------------------------------- — SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Y 134 Sycamore Street 305 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California 1 ES 9 REVISED 9.59 2M 5-62 ATLAS - ,- � I