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FOR OFFICE USE: ------------------- APPLICATION FO SANITATION PERMIT Permit No. . 1.. � -----•-------------------------- --------------- (Complete in Duplicate) ------------------------------ This Permit Expires 1 Year From Date Issued Date Issued . Application is hereby made to the San Joaquin Local Heal+h 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 LOCATI N.. . __._ ----------- - -------y /T1.__•-•-••____-----_ Owner's Name. -•---- -------- ------------------- Phone.................................... Address..... .7•,3 't -------------------------•-----------._---------._-..-•--------------------------._..----p...._... Contractor's Name_.----- • Installation will serve: ResidenceS Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..___ Number of bedrooms J__.- Number of baths -Z--- Lot size ------- _.O Z 1 Water Supply: Public system ❑ Community system ❑ Private DO Depth To Water Table 10`ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ® New Construction: Yes Eff No ❑ FHA/VA: Yes ❑ No 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—K-0 Distance fromfoun dation__-./a-__.____.Material-____ _____ ------- No. of compartments______..-______________Size7_9_�C_/ aXr2_.__.Liquid depth----- --_--------Capacity.. A/ . . Disposal Field: Distance from nearest well-_._`O___.._Distance from foundatio 4_ __,1 __ __Distance to nearest lotNumber of lines-{_____A-..._..____ Length of each line idth of french----z__ --- Type Type of filter material--� ------------Depth of filter material____1?__________._Total length_._....1Q__ _______________•-__ I Seepage Pit: Distance to nearest well____1!?IJ...______.Distance from foundation-__1,0*.__.__.Distance to nearest lot line.....:55 .._ Number.of pits---[_2,----------Lining Material---------------Size: Diameter---- -�-` -Depth- f----------------- i Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_--...-________________-.._____:;:_._ Size: Diameter----k---------------------------------- Depth ---=---------------------------------------------Liquid Capacity........••------------------gals. Privy: Distance from nelarest well------------------------_------------------------Distance from nearest building_____________________-_-...___.___.___.._. ❑ Distance to nearest lot line Remodeling and/or repairing (describe):------------------------------------------------------------------------- ±. _______________________________________________________________Y___________.____________-_-___________•_____-_.-_______-_-_...._-_.____________-_•--__________._______.._.-_•_----___.____....._-»..____________•--__.___.._- < . e f 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. (Signed) -- _. -------------------------------•---------------- --__ __ -__{Owner and/or 0� r Contract )l ±, r By: C--- (rile) , (Pio} plan, showing size lot, location system in Tela}ion to wells, buildings, etc., can be placed on reverse side). �.- t:. I FOR DEPARTMENT USE ONLY ' ^-{ APPLICATION ACCEPTED BY----- ---1 1 C-/. I ---------------•----- DATE------ &.7--- :v. REVIEWED BY ` DATE-.----- --------------------------------•------------------------••- ••----- A ------------------•--------------------- ------ BUILDING PERMIT ISSUED----------------------------------------------------------------•--•---.. ---------- TE Alterations and mmendans .JJ f ---- - ---•-•----•--------••--••--------------------------•---------------.....--•-----•...----.----- .. - ----------------------- FINAL-',-INSPECTION BY:..-.lGY _I.. C� -------------- Date--------------------- -------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California f % Lodi,California Manteca,California Tracy,California r ES 9 REVISED 5-59 2M 5-62 ATLAS