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FOR OFFICES USE: -------------------- -- -------- APPLICATION FOR SANITATION PERMIT Permit No. ----- ---------------- --------------------•------- (Complete in Duplicate) -- ----------------- ---------------------- - Date Issued - - - - - This Permit Ex fires 1 Year From pate 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 wit Ca:; tn a No. 549, JOB ADDRESS AND LOCATION-_-_---.-- l ---------------------•-----------_--- .---------•-- -- ----------•----• ------Owner's Name. `'•- JZ '�S_! �` a ------- ------ Phone- �` "�.�ri Address ------------ ` G --•-------•----•---------•-----..-•----••-------------------� -••------•----•------••--- Contractor's Name -•�----��.----------•............. -------•---------• Phone` _r_ . . � Installation will serve: Residence © Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: --i--__ Number of bedrooms .'2'__ Number of baths ----I--- Lot size .._ {.-_- -_-% l d ----•-- --•---------•--...----- Water Supply: Public system Q Community system E] Private El Depth To Wafer Table 1-: . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe ti ti�Hardpen ❑ Previous Application Made: (If yes,date.-------------------) No E3-"New Construction: Yes ET-IIN'o ❑ FHA/VA: Yes ❑ No 0� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan : Distance from nearest well------------------Distance from foundation,------------------.Material--------------- .._.____.___-- No. of compartments--------------------------Size--------------------------------Liquid depth__------------------------Capacity._ Disposal Field: Distance from nearest well_._YtAhL---Distance from foundation... p--`-.--_.Distance to nearest lot line__. I � Number of Lines---------- -(-----------------------Length of each line----•--.ate__- Width of trench---•_-j'----•--- Type of filter material.__-.IL! !_- Depth of filter material___..-8_____________Total length_____-_ - _ __.___,- _- eepage Pit: Distance to nearest well______________________Distance from foundation_______.___. -..__. r' Distance to nearest lot line_________________ ! � q`gk 11,4umber of pits----------------------Lining material---------- ------------Size: Diameter------------------------Depth---------------------------- t Cesspool: Distance from nearest well________________Distance from foundation..____--------------Lining material-------- N ' El Size: Diameter--------------------------------------Depth-------------- ------------ ----- ----------Liquid Capacity -------------------- ___.________..____..__ . -----•-•---------------gals. Privy: Distance from nearest weft_.____-_______________ _ __ ---_______._Distance from nearest buildin ❑ Distance to nearest lot line--------------------------------------- 9 e� i e(nodeling and/or rreep'ir ng ��iescribel---------------- - �� -� - ----- ------ 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, --------------------------------- SI nedD n -- ---- ---- ......4 -- -- '_.._._____(Owner and/or Contractor) Br �' -a�-----' (A --------- Title { 1 ''�' 1f�'d ------------------ --- - (Plot plan, showing siz"f lot, location of system in relation to wells, buildings, etc., can be placed on reverse side), f7ir E FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - ----- ---R �- DATE_--/f Z .--- . REVIEWEDBY--------------------------------------------------- ----- ---------------------------------------------------------- DATE BUILDING PERMIT ISSUED--------------------------------------------------------------•-•------------------------ -- � - _ - 1.rl.-¢e'ms* ,►- -AFeratios and/or k=�:; ------ a •------------ ------ -----------�• --------'--------- ----r_ --------- . _,. -------------- FINA?R NSPECTIDN B y- - - F., Date--------- J- s-fit•; = 101 rte" &,,%&QUIN LOCAL HEA pl ICT 130 South American Street 300 West Oak rreet 7 t 144 5ycomore treet 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California I ES 9 REVISED B-59 2M 5-62 ATLAS ]i 1