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F�R OFFI E USE: -_&!,� 3/i�/ o ;,J-: . -1-1, ...... ..........�.___.__..._ ._--.__ ........ APPLICATION FOR SANITATION PERMIT Permit No. ...!_ ...� ------------------------------------ (Complete in Duplicate) �1�/ r This Permit Ex ires i Year From Date Issued Date Issued .__-----.1 -,.- 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 Ordinance No. 549. JOB ADDRESS AND LOCATION-------- -3--- -- t-v e�, 77 Sf Owner's Name -z ,�.... ------------------ Phone.................................... 7.Address >l• Ste` --------I ------------------------- Contractor's Name................ f:� - -.. � /.- --. ----- Phone................................... Installation will serve: Residence [9�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---2----Number of bedrooms __J. Number of baths ___' Cot size ........ r� � � " .. Water Supply: Public system [ Community system ❑ Private p Depth To Water Table3_u ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Of yes,date---------------.----1 No New Construction: Yes ❑ No [Q--FHA/VA: Yes ❑ Nom_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �S Tank 1 Distance from nearest well_____ --.Distance from foundation_____�-�------Material.____ J//�'� No. of compartments q p t_ __________Ca Capacity p --------- -- X X -Liquid de th P tY <• Di osal Fi d: Distance from nearest well----- _Distance from foundation-------:5. ._0-_.Distance to nearest lot �S g --------Width of trench ------ � Number of lines___..____l_ .._._Length of each line.___________ _-•-•- Type of filter material._. $ Depth of filter material__.__? ____Total length............. _2_-`_--_________ _ Seepage Pit- Distance to nearest well-------_,.--_-____Distance from foundation------e'� '_:.Distance to nearest lot line........:_ �. � Number of pits----.___-,/_.______Lining mate ria l_.__��--r��.Size: Dia meter__.•._7�-__-------Depth----------- '______...__. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.--.__-_._-_-______.__________._.... ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------ ---•-------•--9als. Privy: Distance from nearest well-----------------------------------.-----_-------Distance from nearest building-----------..-__-_______-_-_-__-...___,__. ❑ Distance to nearest lot4ine----------------------_------------------------- Remodeling and/or repairing ( -_..-_----•-�-� `-��`-'"�- --� �v �� e _a.. r_ -----------------------------------------------------•--------------------------=-------------= 1 hereby certify that I have re ared'+his,a lication and that +he work.will be done in accor--- __ ______________________ _______ n - Y Y P P PP dance with San Joaquin County , ordinances, ws, and rules a d regula ' sof the San Joa rel Health District, j (Signed)-•-- -- ----- -- •�----� -------------------------------------------------- .Owner and or Con+rac4or - - -- BY ....................................--•---------------- == ----=--------------- ----------------------------------------------(Title)----------- ------------------------------- (Plot plan, showing size of lot, location of systern"in:relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -2Q''"` DATE REVIEWEDBY = ... -------------------------------------------------------- DATE.._._------------------------- I BUILDINGPERMIT ISSUED------------------------------•--------.------------------------------------------------------------ DATE. Alterations an /or recommendations:-------------------------- --------------------------•-•-•-------------..... �.L/�4 fl -.�-.:: ��'" r. �.9-� ------ ''/ ----••---- = r�¢��a ',� •-••-----------•------ -----•--- --•----------------- ----------------------•-•-----------------------•----------------•---•---------------•-----••---------------•--•----•-------------•-- --------------------------------------- ----------------------------------------------- --- ---------------------------•-------------•--------------------------•-- •--••------------------ f FINAL INSPECTION BY------ -- ------- ---- --------- ,f.? '— Date-------------- -------••--------•---•------- SAN JOAQUIN LOCAL HEALTH DISTRICT � 130 South American Street 300 West Oak street 124 Sycamore Strutt 2X Stockton,California Lodi,California Manteca,California I ES 9 REVt5E6 8-59 Z.F`1 5-62 ATLAS - 6