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FOR OFF E. ------- v ------ - APPLICATION FOR SANITATION PERMIT Permit No. .., :� 7 -----------------3. {Complete in Duplicatel f This Permit Expires 1 Year From Date Issued Date 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 with County Ordin ce No. 549. j-73 — JOB ADDRESS AOC � �ve.g----�J ...— ---•--. ------------ /L - -------------- Phone---------------------..-_----------- -'-----------------•----------------------•---•----•-•------••---------•---._- Owner s Name------ _O.Yy ---•---- • � r Address fG.....- - Q � ---� --------Contractor's Name..----------•------------------/---- � �- -------------------------•- -----• ----------------- Phone............................. Installation will serve: Residence�52,'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ S" Number of living units: ---/--- Number of bedrooms __ . Number of baths) -Lot size .................. ...-,l -------------•------•- Wafer Supply: Public system a---c-ommunity system ❑ Private ❑ Depth To Water Table `5..,7ft. -- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ �a?nd �am ❑ Clay Loam ❑ Cla Adobe ardpan ❑Previous Application Made: Ilf yes,date-.-------_--_----.-I No ew Construction: Yes o ❑ 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-----------------Distance from foundation--1 s/....--.Material---------------64f,---------------------- --- L�_ No. of com artments---- Size--_.--.--- $( -. l _Liquid de�'�f�'* ---Capacity_.�PT--- .---- Disposal Id: Distance from nearest well-----------------Distance from foundation.__-`_�---1------Distance to nearest lot line--4-- � Number of lines___-------- Length of each line----p-_S�-2=r----Width of trench--_-,?1V----------------------- Q Type of filter materialh� . .ICDepth of filter material___.1- .-�----__Tota! length--,/,& _f----------------------- Seepage P' . Distance to nearest well II------------------ Distance from foundation-YA_/---_--r i,ance to nearest lot line-§7---.. --- .... Number of pits.---.• ------------Lining material.'�'.`oG--it_----.Size: Diameter--- ----•-------------Depth----..�.,5---.....-------.._.._ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material..----------------------........---- ` ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity---------. -. ------------gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building---..---_-._--------.____---_:_.---------- ❑ Distance to nearest lot line--------------------------------------------------------------------------------------.....-•--------------------- ---••--------------------- Remodelin9 and/or repairing (describe):------------- 7 '�J t ------------------------------- ------------------------•--------------------------------------------------------- --------------- ......... ------------......_..... --------------•-----------------------••--•----------------------..-•- ---- ----------------------------------------------------------------------------------------------------------------------------------------- hereby certify tht I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a rules and r,g tions of the San Joaquin Local Health District. (Signed)--- -------- -- wi. TAT - -- ---------------------------------------------•------------------- Owner and/or Contractor) By:---------------- r ------- 1 � {Title).... -- ------ - {Plot plan, showing size of ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.A..I- r- 6 '" r DATE . = + REVIEWEDBY-------------------------------------------------------------------------------------•---•------------------------------------ DATE.------------------------------------------. ------------- BUILDINGPERMIT ISSUED-----------------------------------------------•------------------.-.....-----------------------•---- DA-TE---------.--------------------------------------------------- Altera 'ons and/or re o mendati ns:-------------- ----------------- '-'---• -------------- - -------- - . - . f ----` -------- -- - ------------ . = :- - - --------------. -- ------------------------ - ------ --- ------- ---- FINALINSPECTION BY:--......+ 7CGd`_'---------------------------------- Date--------/---&741,------•---------------------------•----------- 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 ES 9 REVISED 8-59 2M 5-62 ATLAS