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FOR OFFI EISE: fi - APPLICATION FOR SANITATION PERMIT Permit No. - --- -------- ----------- - - ----- ------ -------- (Complete in Duplicate) _-_-//..�_7__-. �� --------------------------- ----------------------- ----- 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-descrUi d. This application is made in compliance 3th nt Ordinance No. 549. JOB ADDRESS AND LOCA 10 Owner's Name =--------------------- Phone........- / ---....---•-----•---•--••----------------- --------------------------•----•------- -• _ Address 'n [.-- I S �T�' Contractors Name •---..__ Phone................................... Installation will serve: Residence [!T—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -J-_-- Number of bedrooms __.- Number of baths 1...... Lot size A A-2.12..................................... Water Supply: Public system E�" Community system ❑ Private ❑ Depth to Water Table�,5.?�_. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0' Hardpan ❑ Previous Application Made: (if yes,date--------------------) No Er New Construction: Yes J" No ❑ FHA/VA: Yes ❑ No ®-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septi j nk: Distance from nearest welfn' `�___ Distance from foundations ..............Material__ _..__ ........................ Lf No. of compartments________ ______________Size__3 xS g °o Liquid depth y- ------._Capacity------- ...---.._. r .. -Disposal Field: Distance from nearest well__"'----------Distance from foundation../d��....Distance to nearest lot line_____....__ E�r Number of lines--------------d--------------------Length of each line-------------------------Width of french-------`�-y...................... Q Type of filter material---�_�_'c�----------Depth of ,filter material ...L?!--------------Total length______=� _�___________________------well------ ----------Distance lot `U I ED' Number of pits-----I----------------Lining material__'FaC/L-----.-Size: Diameter----- 3-----------Depth----------- ;24_�------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_.._____....______________-____._._-_ ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------_---------Distance from nearest building----------------...........____...... ClDistance to nearest lot line-------------------------------------------------------------------------------------_.----------------------•-------••-----•-•------------ Remodeling and/or repairing {describea=----------------------------•-•------ -------------------------------------------------•---------------•--------•----•----••------•--•--------•--------- i ----------------------------------------------------------------------------------------------------------=---•-----------------------------------------------------------.---------------•--------------------------------- ------------------------------------------------------------•-----------------------------------------------•---------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulat' ns of the San Joaquin Local Health District. (Signed) .-----•---- Owner and/or Contractor 4 By:------------------------------------- A—,---- _- -•-•--------•--•----..------------.-----------------(Title)--------------------------------------- - ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �, OR DEP TMENT USE ONLY APPLICATION ACCEPTED BY--------- = _e_.� ------ DATE------------- `.Sri------------ REVIEWED BY----------------------------------------------------------•-----------------------------------------------------------------.DATE----------------- ------------- .................-------- BUILDING PERMIT ISSUED f -------------...---• --- DATE------- Alterations and/or recommendations:.---,5/ / �- f!( rr -------------------------------------------- - --------- ---•--------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------•-------•--- -------------------------------- -------------------------------------------------------------•---------- •- -- ---•---- ----•--------------------------------------------------------------------------------•------------------ ..................... I FINAL INSPECTION BY: - -------- Date-------sl--- �� -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 19-59 2M 5-61 ATLAS