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FOR OFFICE USE: ---------------------- ___.___._._________._______.. APPLICATION FOR SANITATION PERMIT Permit No. ...1 --------------------------------------------------------- (Complete in Duplicate) 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 application is made in compliance with County Ordinance No. 549. k� `.•� a i JOB ADDRESS AND LOCATION - -�- V:�-•------------------•-•---•----------•-----------------------------•-------- t .. , / Owner's Name..... r� .�?M ------ --•------- Phone.►h.... r� 7 Address---------------------- -•------CL--'-�"�.`-a'=-�'".................-•--=�......•-------------------------------------•-----------------------------------------------.........-................•-•-•----�. Contractor's Name � �f------=�---�-°`'1 ., r��r �.t'3,.� Phone.�,�P1, ��1�&j Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1____ Number of bedrooms .- Number of baths ---i... Lot size .................... r • Water Supply: Public system Q1-1Community-system ❑ Private ❑ Depth To Water Table 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 ❑ New Construction: Yes E;�<o ❑ FHA/VA: Yes ❑ No QQ'�' 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_..._....__.:.................................... G :- . . No. of compartments- --- -----------Size--------------------------------Liquid depth--------------------------Capacity---- -------••------ Disposal Fiel Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line._______.___...._ Number of lines------------------------------------Length of each line-.----------------------------Width of trench----------------.--------------.--- tl Type of filter material----------------_--------Depth of filter material-----------------------Totallength------------------------------------------ Seepage Pit: Distance to nearest well'`f".�� f_______Distance from foundation...!.A...____....Distance to nearest lot line................. ©� Number of pits------1--------------Lining material___+ .__.Size: Diameter__-a_ :_'.___.____.Depth_-_ 4_..��? _..... Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-_________--________-___-________---- Q ❑ Size: Diameter--------------------•--- ------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____________________________-_.--__---. ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------� ------------- •--------------- Remodeling and/or repairing (describe):--------- ----------------------- "t `-"'^ ----- -----` -----_`-.� ....:�.. ............................... --------------------------------------------------------------- --•------------------------------------------------•-••------------•-------•-------------------- f 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 regulations of the San Joaquin Local Health District. 1 R ' / ! (Signed .-• -•• ``cf1� -' J �h?- D = (Owner and/or Contractor) _-_ 1 ----- ----- (Owner By ...... ----- --------------------------------------------- fr+le] =n- , -- -------- ------------- (Piot plan, showing size of t, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE r" 2- `�_�= - REVIEWED BY------------------------ ----------------------------------------•---------------------------------------- DATE---•----•---•-----...__....- ------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------•-----••---------------------------- DATE.-------_----- ----------------•---------- AFterations and/or recommendations:.-. -----------------------—___ _- ' --=-.e—z_ --- ---------- c.. -----•----- �{� �!�Q.r�" '� .mss-"� �-C•�`--e'�s..�r-�P d.l�a -- ....................- ---------- ------------------------ -•-- ------------------- - ,.�,� a". /yam ♦.� t �� / _ - =semf� __!-'�4 ..-. :.IQ �' !'�=At`-tr•��:____ :_J:_` !�!"�.,�,+4!�.! ..-r•!sy__.�?.�?_/T.+,�!' �1. ;,.F t'.._ _!'•L.._.�!!?!'!y'--!':_--- , --! /!�-----------------------'___ �• - _. FINAL NSPECTION BY-------------------------------------------------•-----------•---- Date--------- ------. -`- •` - �y 6 ' e` _ � ° �'"" SAN j AQTJIN LOCAL HEALTH DISTRICT �� j 130 South American Street 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS