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FOR OFFICE USE: t APPLICATION FOR SANITATION PERMIT Permit No. _/(s�..f-.�... r� 6— 5 _� E .-[�.` ! (Complete in Duplicate) ------------------- This Permit Expires 1 Year From Date Issued Date Issued .......... /,o 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. JOB ADDRESS-AND LOCATION ----. 5�/•S/ r� �------------------------- ----•-•-------:------------------ Owner's Name...____- Phare x ' ;�-s - .-•----------------------------- ------...._-•----••----------------- a►3 z,(' w �1 s Address..........•. ?� Contractor's Name.................. OCCTIS{f} ------------------------------ --------------------------------------------------- ........... Phone. -= -•----................... Installation will serve: Residence [0" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ,Other 0 °�- Number of living units: ---I--- Numberof.bedrooms, ^Number o baths,_-��__ Lot size ____.. _. __ _.tom r P Water Supply: Publics stem Co munit system Private 'De th To Water Table ........ ft. Character of soil to a depth of 3 feet:! Sand Dy Gravel ❑ Sandy Loam ❑�'ClbrL'oam..❑__Clay..❑.,Adobe 931"Ha r pa�❑"' �* pp y F ,� ❑ onstru'ction- Yess97No ❑ FHA/VA: Yes'❑ �No`❑ �1 Previous Application Made: (If es,date_______________r�_r_)•••IVo New G _ TYPE: OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is�`availabie within 200 feet.) ' ' �y CA Septic k: Distance from nearest well,,---S' ____Distance from foun�ation____f______ Mater I____/ ��- -•-�._...� ___. No. of compartment ........_ ___. _._"Liquid depth4_..`* ._________Capacity.... 1 1 a _/40------ to nearest lot liq Disposal ield: Distance from nearest well--__t 6--.-Distance from foundation...... . -f:....`f l ____ Length of each line______ �"` `Width of trench___.___ /r Number of lines------�---•---;---•--------- 9 ; •--------77- ----- � -�•'--•-----------��--- i Type of filter materlaL ` . t-Depth of filter material-_!__f ____.Total length_______.._..9 ____________: ' See Pit: Distance to nearest well---__ /.____Distance fro fo rid tion___Y,/T-.____.Distant to nearest lot lipe----.S.i_/-._f Number of pits---.-------/--------Lining materia ,�G- ze: fir----- - ?_,Depth------.-----------A...... Cesspool: Distance from nearest well_____________---D1stane from fo(indation--------------------Lining.,.mater;al__.________ _______--___-____________ ❑ Size- Diameter--------------------------------------Depth----------------------------------------------•-----Liquid Capacit ---------------------------- Privy: Distance from nearest well----------------------------_---------------------Distance from nearest building .__-___-_-______.._.__--- ❑ Distance to nearest lot line---------------------------------------------------------------- ----•------••-------•-----------•-------------------------------------------- E . I Remodeling and/or repairing (describe)--------- ------------------ "----.::::— r ------------------------------------------------------------------------------------------------- ----------------- - --- ---------------- -----------F-------- f - - -----.--- :--... ` I - --------•--------------•--------...-.--------------------------•---------------- ==---•--------------------------•------------ ............---------•-•------------------------------ I hereby certify that I have prepared this application ,find that the work will be done in accordance_ with San Joaquin County, ; ordinances, State laws, and rules and regulations of the San Joaquin Lo'al Health District. V ------------- -:-- (Owner and/or Contractor) (Signed)--•------------------- ----------------• t BY- •-------------------------- ---------------- ------------------x---------(Titlel---J------------------------------------------------.. (Piot plan, showing size of lot, location of system in relation to wells, buildings, etas, can.be plaAd on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ` ------------------------------------------------ ---•---- DATE -------------------------- REVIEWED BY-------------------------------- -------------------------------------------------------------------------------------------•- DATE_------------------------------ -------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------- - Alterations and/or recommendations:---------- • ----------------------------------•_ ---•-----------..._...._.....--•------••--•-•--••------•-•--•---.....•......----- ... . _--- • C-A - - - ... --- --- ::1 -- ------- . _:- °r,�l ... _--'---------- . -- ------- - : .<< 4 ---------------------------------------- --- -----------6---- ------ ---- ---= -- �� ---/-/-- --- ; . .: n - s,---�- . ---------------------------------- -- ------ - -------------- ----- -------- --------------- ..�$_. �4 '� Y'� . F1NAL INSPECTION BY: /s �. --------- ----------------/ ' ------- ----------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS ``