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FOR OFFI 4E USE: E . v - t: ------------- ---------- APPLICATION- FOR SANITATION PERMIT Permit No. :.. 5..._ _. _._ ---------------------------------------------•----------- . . (Complete in Duplicate) 44�(o Date issued 3 _-------------------------------------------------------- This Permit Expires 1 Year From Date Issued 2_0P Application is hereby made to the San Joaquin Local Healfh District for a permit to constru t and instal the work herein described. This a plication is made in corm liance with County Ordinance No. 549. 'a"? Sfa SANTiq `I FD= a f JOB ADDRESS'AN CATION_- _ /.f:- F�� :� ✓ [' . ,7` _-----.-� LOA1 . --r--_... . Owner's Name.. --- - ---------• --fir --��-- ----- ------- ------ --------------------- Phone- , L Address..........` �.e�r.. .... .... ••-- !! 1�. ----. .....•••-•-••-•••....--•••••-•••...... ._..... Contractor's Name-- = --------- ---------------------•--..__ Phon --•- ---... --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ .O_ ther ❑ Number of living units: _j--- Number of bedrooms _ Number of baths L-�.6ot size ..- _._____ _.. ,c ....._._. t Water Supply: Public system ❑ Community system+C] Private epth TO Wa r Table 1: ft. Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ -5jay E]F, /Adobe[:], Hardpan C] Previous Application Made: (If yes,d te-__________________I No ❑ New Construction: Yes Vo HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitfed'if pubic sewer is availe6le within 200'fee+.)-- i Septic Tank: Distance from nearest well ___Q_______Dlstanc from f undation-�� ___.Mf t rial_-___ ____ _�V � ....___..... No. of compartments_ ___________________Sizes�,�`_ _ _,...Liquid depth__ _�l-.___-_-.-CaL1p �j Q 1 Disposal Field: Distance from neaa__47 well,�� ___Distan tom foundation.. sIstance to nearest tat Gne.......... Number of lines__ __-_- - -- _Length of each line ` 'r .-Width of trench._ 'r �...........Type of filter materiaDepth of..filter material____, _`r __Total length_____________________f _f.__ Seepage Pit: Distance to nearest well__________________ __Distance from foundation________-___-----_-.Distance to nearest lot line________________- ❑ Number of pits_____________________Linin material------ `___._#-__.Size: Diameter-----.----------------Depth___________________.._____ Cesspool: Distance from nearest well__:, D'istance,from foundation_-----------------Lining material------------------------- ❑ Size: Diameter------------------------°T!tn-----_-Depth_"r.....4 `--------------------------------------Liquid Capacity ��...s.....---.......gals. , Privy: Distance from nearest well -----------------------____________ __ ______Distance from nearest building-_ ._._..�______.-.--------------------- Distance ti_._____-_____._ _.Distance to nearest lot line___________ ------------------------ - --+. l Remodeling and/or repairing (describe);________ _______ ------' ". :W.-._. M .ti I I - 1--•------------ ----- - --------- -------------- - --- ---- -------------- k_____________________________________________________________________ -----------------------------------_A--------------------------------------------.----------------------_____-_________________________ i I hereby certify that l have prepared this application red that +he work will a done in accordance with San Joaquin County i 1 ordinances, State I r les and regulation of th sn Joaquin ocal He District. 5i ned �Z - � Al i------------------------------ or Contractor --- T Plot Ian, showin=---srze of lot, location of s s+e r rely ren to wells, u'�-------------•�---------lrtle}_________.-:.______-_...__.___._-__.____-.- ._.____�_.�_:� �--- Y' +, . ( p 9 y ridings, etc., can 6e placed on reverse side). � Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- F _'-------- -------------------------------------------------------- DATE-------- REVIEWEDBY-------------------------------------------------------------------------------- -------- ---- - -------------------------- DATE----------------------------------.................. BUILDING.PERMlTPI55U.ED.==_..::. •-r== ...._:=F = ----------------------- Alterations and/or FecordWend'afions:-----•--------------------------- ------ =�...- ---------------- ......................................................................--...------------ { ....................................................... ..................... -------------------- ------------ - ------------------------------------ ----------------------------- ------------- ,'------------------;-�-- --------------------••----------------------------------------------- ---------------------------------- ---------------- ------ ------ ---- -------- --------. FINAL INSP -- -- ------- ---- --- -- -- Date.-- V-------/ ---- ----------------------------- SAN ---------- ------SAN JOAQUIN LOCAL HEALTH DISTRICT f 130 South American Street 300 West Oak Srrest 134 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS - f 3