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- - - -- --- - rt��rr��USE: :r ' � � �s1� .. - r_-- -. APPLICATION FOR SANITATION PERMIT Permit No. ......... ... ' (Complete in Duplicate) l This Permit Expires 1 Year From Date Issued, ate�lssl�le ----- s ` 7��Z Application is hereby made to the San Joaquin Local Health District for aper it f n s#a�I;Pub3_wdrk�}t re' scribe . This application is made in compliance with Co Ordinance No. 549. �be fI t JOB ADDRESS A LOCATI ^1� *_ o Owner's Name dim = = / .' '°--•---- ------------------------------------ ------------------ Phone-..... Address... Dd�---�-- --------------------------------- 5_2�"-- i. Contractor's Name ...------•---•-----.-- - Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __r----- Number of bedrooms 6-_-- Number of baths Lot size / p,�C/ b5'°--_--.--__-•____________ __ Water Supply: Public system ❑ Community system Private ❑ Depth ro Water Table 46-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff"'Hardpan ❑ 1 Previous Application Made: (If yes,date--------------------) No [T/ New Construction: Yes eNo 0 FHA/VA: Yes 2�""No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pe4 rmitted if public sewer is available within 200 feet.) 4 Septic ank: Distance from nearest well--------- -._Distan from foundationf,9.�_....--_--_.Materiak_- ________________________ _ No. of coin artments_ t? (1(?---•-..Li uid de th- ----Capacity-_`_:c+.¢• n P ----�.�-.-----------------Size---• ---- - q P. ----�'-�-------- ------ U V' Dispos I Field: Distance from nearest well__-- ----_------Distance from foundation_1_•6.1____________Width of trench.-��.,-----------.Distance to nearest lot lines'"_--....-. Number of lines-------�_-----._-.-_ ---_._Length of each fine.--:7�______ f -Type of of filter material.-. GL[---__Depth of filter material-----------------------Total length------ ._---. ----_---------- Seepag Pit: Distance to nearest well------ �_--------Distance from fougdation.0__- ..........Distance to nearest lot iine__ Number of pits---.`.�-----------Lining material��C.�--------Size: Diameter-----�-,�-�-------.Depth----��_'.--------- ---- t) ------------- Cesspool- Distance from nearest well----.._-_---_.__Distance from foundafiion____________________Lining material.- _---------------__-----_- ❑ Size: Diameter---- = =M1 ---------Depth------------------------------ - Liquid Capacity.----..--' gals. Privy: Distance from nearest well.-.._-__--._..._"___-----_-_ ------------------------------Distance from nearest building__________________________________________ ❑ Distance to nearest lot line-_-----------------------•------------------ ------------------ --- Remodeling and/or repairing (describe):---_-----_- ---•------•-•--------------------------- --------•-------------:-- •• -- -------•-----------• ----------------- ------•;-•----------•---------------•--- . -----•----------•------ --------- F I hereby certify that II have prepared this app cation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules andreg tions f the San Joaquin Local Health District. (Signed) ••-- --- -------- - ------------ --------------------------------------------------------------_(Owner and/or Contractor] �s BY� ------------- -•-•--. ..... . . ------ --------------------------------------------------(Title)----•-------------------------------- ---..------ - --------- (Plot plan, showing size of to , on -f system in relatil n to wells, buildings, etc., can be placed on reverse side). _ FOR.DEPARTMENT USE ONLY �U APPLICATION ACCEPTED BY-----_ --- ----------- DATE_ REVIEWED BY ----------------------------------- - -- DATE -----------------------------------------------------PERMIT ISSUED---------------- --•------- DATE- -- .. _ ---•----- - Alterations and/or recommendations:_. -...y1Q7',Etr _-_.,tea �f ...- - - ---••------------------------------------ .G. -------------------------------------------------------------------•------------•---....------- ------------- -----_----------- ----------------------------i------ FINAL INSPECTION 8 .. --•-e ------ ----- - _-- _ Dete- --- e i ------ l; SAN JOAQ N LO AL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Strut Stockton,California Lodi,California Manteca,California Tracy,California 1 E5 9 REVISED B-59 2M 5-62 ATLAS w