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FOR OFFICE USE: T= --------------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __ !P!_...._... ---------------------------- --------------------------- (Complete in Duplicate) - --- This Permit Expires T Year From Date Issued Date Issued 25� lf0'- Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'nstalllhe work herein elescri This application is made in compliance with County Ordinance No. 549. l �'h.t` s�, d3 � j 44( JOB ADDRESS ANDATION..; ' !�.�_ -- --�--��-T-�=----?---�--7�--- -- ..------.. . - Owner's Name_,--_:i-'= ---.—-:— __. _ - ----------- --- e Phane.. . . .----•-•-- -- Address.................. Contractor's Name---___-_, } ----------------------- --------------- -------- ----------- Phone......47'3-:-!a9.7 7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: -_Z Number of bedrooms __-a��___.;Nurnber of baths ___L Lot size ..._.._�6_.._ ....... n Water Supply: Public system ❑ Community system ❑ PrivIa te ' Depth to Water Table ........ ft. n j I Character of soil'to-a-depth,of 3•feet:• Sand,; Gravel-E Sandy Loam ❑ Clay Loam ❑ Cay ❑ Adobe❑ Hardpan ❑ ; Previous Application-Made:-(Ifyes;date__�:_- .�"'}"No`.❑ New Construction: Yes�No E) FHA/VA: Yes, No [ITYPE OF INSTALLATION"AND SPECIFICATION! . No septic-tank-or cesspool-.permitted-if public sewer.-is-available within-200-feet:) Septi Tank: Distance from nearest well _______Distanc from foundation--- _________ ......Mater•ai______'__-.-__._______._...____.__ Size S Li uid de th '{--. - p No. of compartments_---___.�--------- �� q p ..- ...____Capacity. O ; 4 '". Disp s I Field: Distance from nearest well___ ____________Distance from foundatioA____ -. ... Distance to nearest I t !i �.,�...... . Number of lines__�___.. �____ Length�,of each line�4_______ _.__ Width of trench_____________ r� Type of filter materia __________________Depth of filter material.-----_� ___ -Total length___......_____�i Seepage Pit: Distance to nearest well-----------------------Dista a from foundation.............-------Distance to nearest lot line_----__-______-_ ❑ Number of pits---I------------------Lining mate}rial_� --------Size:Diarpeter--------•--------------Depth-------•---------•---------------- Cesspool: Distance from nearest well-----------------Distance from foundation--_-_____._1__-.Lining material......................________-----•- ❑ Size: Diameter----- ---------------------------------Depth ,-----•-------•-- ---------------------------'-----Liquid Capacity----------------------------gals. Privy: Distance from nearest well--- ---------_______- -__---- -__,_�-Distance-fr"om nearest building___________________ ❑ Distance to nearest lot line-' -' . . , 3 Remodeling and/or re airing (describe)_-------------2-----------------------------------------------------------------------; .-----••------------- -----------A \1 rZov.Gtt '"�K N�? --=`-�----:t?fel_42E�f.S'r_f�nCs------=-�/S,l.; _��f-.F-------T�F�.-�,�,-------- I hereby certify that I have prepared this applicationand-that-fhe-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)----------------------------v=J--------------I ------------------------------1--__----------------------------- ------------------------------------------(Owner and/or Contractor) BY:------_ x = = "` = ------=-=---------- �:_._-- -"--_---=-= ----'(T'ifle)------- ------- -...- ..:'� (Plot plan, showi size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORtDEPXRTMENT USE ONLY _ - i 4 APPLICATION ACCEPTED BY f f ------------------- ------------------------------------- DATESZ REVIEWEDBY ------------ -�---•----•---------------------------------------------------------------------------•-- DATE-------•--- . BUILDING PERMIT ISSUED...-- ....± ------------------------•----------------------------- ---------- DATE------ --------- Alterations and/or recommend'afions_____ ______________ .__ __ ._.__._. ._____ ___ _ ------------ .................----------------------- --------------------------- -----•------------------ -----------------------------...- ---------------------••-•-•------------------- ....................................-------------------------------------- ----------------------------- i ------------------------------ ----------------- -----------------•--------------------------- --- FINAL IN .- ------- - Date---------- ��' 6/"s ' 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 ES9 REVISED 8.59 2M 5-62 ATLAS �- a �l r i f