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FOR OFFICE USE: 5 -------------------------------------____________________ p __________________ _____________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ..9./ .....�... -------------- ------------------------------------------ (Complete in Duplicate) ------------------- This Permit Expires 1 Year From Date Issued Date Issued ..r ......_._____._ � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrl ed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI N�_ ------------------------- Ofl wner's Name Nams: -------- ------------------------------------------------------------------ Phone.-_g Address - .--•------�1- - �- C' ----- --------------------- --------------------•-------•--- AX Contractor's Name.....! !1_ f3 . Phone ✓v7.3vl �7 Installation will serve: Residence M ' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -;32__ Number of baths ___ Lot size ..... _ ---------SP1___________________ Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table 3-157-ft.' Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________.) - No;Y -New Construction: Yes ❑ No)4 FHA/VA: Yes ❑ - No 0`7 " .E TYPE OF INSTALLATION AND SPECIFICATIONS: v� I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' { Septic.Tank: Distance from nearest well------------------Distance from foundation___________________Material___-_--___ __--_-.._--_-_---_-___________- ❑ No. of compartments------------------ Size --------------•---Liquid depth---------------- ---------Capacity....................... Disposal Field: Distance from nearest well_____ Distance from foundation{...f_F_--_....Distance to nearest lot line....1d....... ] _.__ Length of each line_. -0___�~'�_'-___..Width of trench ��____________________ Number of lines_________________ r _ _ 7 = Type of filter material.--_. _ _Depth of filter material______��_f�.____Total length____-_-_+ �____. _V.___.. y Seepage Pit: Distance to nearest well----_------------------Distance from foundation--------.-----------Distance to nearest lot line----------------- ❑ Number of faits----------------------Lining material-----------------------Size: Diameter----.-.-------.--------Dept h_---_---_.---------..------__--- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material------------------------------------- El Size: Diameter--------------------------------------De th------------------ --------------Liquid Capacity.. --.gals. l Privy: --- -------------Distan�a from nearest building-----------..--.---•---------------------. ')� Priv Distance from nearest well_____________________________ _ v ❑ Distance to nearest lot line----------------------------------- ---------:- -----------=--=--------........................... ......................--•--•--- Remodeling and/or repairing (describe): &4 X`----. G ._.... ....................... .......................•---------_-------------•--------------•----------------•---•---•-•------------------------•--------- ---•---•----....------.-..-..........-•-------- � -. _ -------- _____ _______________________________________________________________________________________________________________________________________________________________________________ 1 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)-------- : ------ 2 ----- ---- -- ------------- ------------------------------------------(Owner and/or Contractor) d7. ?-r✓ By:--------------- ---= -------------------------------------------------------------------(Title)--------e6�` G✓ l/f..------.-------- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). Lf FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 `r` '---------------------------------------------------------------------- DATE-------- ------------ REVIEWEDBY-------------'-------------------------------- -------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations-----___--- - - -------------------------------..........•..............-....-.--•---•------.------------------------------------------•---------------- ---------------------------------------------- -------------_------------------------------------------------------------------------------------------------------------- --------I------------------------------ ________________________________________________________________ ___________________________________________________________________________eo�........_..__.___.._....------------------------------------.-_.-_-_____--.. ________________________________________________________ ________ __ _________________________ ___ _______________________________ ------------------------------------------------------ ----------------------------- ______________________________.......... ______ _ _________________ ______ ______L---7 __________________ ___________________________________________________________________________________________ FINAL. INSPEC BY:. . . ��----------- - -� -- - i Date--------------- --•---------------•------••--- SAN JOAQUIN LOCAL'HEALTH DISTRICT ' 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California k E5 9 REVISED 9-59 2M 9-62 ATLAS 7