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FOR OFFICE USE: � .. - ---- ------ Permit No. _ -•------- ----------- ----.... uq(. :_.: °E t. -_r�_-4-(-"" AppLICATION FnR SANITATION PERMIT ."_ (complete in Duplicate) - ---- Date Issued .,1... .�ct_,l This Permit Exgires 1 Year From Date Issued --- --- ---- _ . A lication 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 Ordinanc No. 54 JOB ADDRESS AND L TION•--_•__w�---�---- ; •-----... -•__... pf?:' 2-�� ' ----..-Phon ...... �a .. Owner's Name..............- ----�•-� -` Address--------------.................. �---------------------------------•--------•------------ �� —�; �7 --- L -------- --- �'=-•-•-' - Phone _..... ------•--------------•----- Contractor's Name.- ••--•- -- ---_--• •-Installation will serve: Residence&--Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ____ Number of bedrooms .- Number of baths /_." Lot size Number of living units: _� --- "- Water Supply: Public system,, Community system ❑ Private ❑ Depth to Water Tableft Hardpan C]Character of soil to a depth of 3 feet: Sand E3 Gravel F1 Sandy Loam Cl Clay Loam [I Clay ❑ Adobe Previous Application Made: (If yes,date--------------______) No ❑ New Construction: Yes ❑ No,)<' FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1c Distance from nearest well----------•------Distance from foundation---.--------_---_Material-------------------------.•........... .. ..... No. of compartments-------- ----------•------Size--------------------------------Liquid depth.•----•-----•-----------•-Capacity--------•--••- .� V �rr /�... pos Fieri: Distance from nearest welL_li`1�1 �Distance from foundation__.. Distance to nearest lot line__.. ... > � Number of lines------- ------Length of each line"Q---!n-----------Width of.trench't _r----•----- I De th of filter material----./.9-<<""..__Total length-----. ---`'-- � �}— Type of filter material.__.- --- p �=- " i Seepage Pit: Distance to nearest well�� ------Distan fro foundation/-�_.._ st��a�n�te to nearest lot line.... ' Linin material -- "-- Size: Diameter----•""-_- ------•---.,Depth.." -•r-------------- ` Number of pits.________________ g I - .'.: Cesspool: Distance from nearest well_________________Distance from foundation___--____.____--_-�-Lining'material.___..__.__.___--•--------••-"-"-als, I ❑ -----------Depth--------------------- -----------------------------Liquid 'Capacity--------•----------......g Q Size: Diameter-___-._____-- rest building________ Privy: Distance from nearest well-------------------------------------------------Distance from nea .-----•-----•-----•-----"-------•- ❑ Distance to nearest lot line-----------------------•-- -------------------••----------•--- --------------- •- --- _--------- t Remodeling and/or repairing (describe w •---------------------- _______________________ , -------------- ------------•---------------•------ ----•--------------------•------------------•---•-------------------••--------•---•------------- :------------•---------•---- --- ------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules and regulations of the San Joaquin Local Health District. ! irP_� _" ' } i (signed)- `---- ---------------- --- Contractor _ �s By:.......... •--------•-•-------------------••------------•--- ---------- � -------------------(Title)--- M ----------...- .............. (Plot plan, showing size of lot, location of system in rela# n #o wells, bui Ings, etc., can.be laced. on reverse side]. FOR DEPARTMENT USE ONLY - ---- DATE__ �-- --�r- ------..-_------------- APPLICATION ACCEPTED - ------ - ----------- REVIEWEDBY---------------------------------------- '---------------------------------------•---------------------------------------- DATE------•------------------------•-----------•--------------- --- --------- DATE - BUILDING PERMIT ISSUED-------•------------ Alterations and/or recommendations------------------------------- ----- -------------...-------•------------------------------------ ---------------- _• -----------••--------------------- ' ____ __________ _____ ---------------------------------------T .. Date... - ---------------------- FINAL INSPECTION B �"�'� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Slnof 300 West Oak Street 124 sycamore Street 205 West 91h Street Stockton,California tocil,California Manteca,California Tracy,California E8 9 REVISED 0.59 2M 5-61 ATLAS '