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rVK vrr�i,t u t: f �!`2 ------------ k APPLICATION FOR SANITATION PERMIT Permit No. -------------•---------- (Complete in Duplicate) / -------------- --------------------- ----- This Permit Ex fres 1 Year From Date Issued Hate 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 compliancp<with County Ordinance No. 549. I JOB ADDRESS AND L CATION------ -" j_. --------- -------------_ L -_---Owner's Name ...... -• 77 Address--------•.............. ----- ---_------ •-- ontractor's Name... '.. _rPh . Z,� Installation will serve: Residence �( parCommercial Apartment House ❑ / _ E] Trailer Court Motel� Motel ❑ Oth ❑ Number of living units: A...... Number of bedrooms -Number of baths ../__-- Lot si e -,� ------------------ Water Supply: Public system 5. Community system ❑ Private ❑ Depth to Water Tab --- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeo Hardpan ❑ Previous Application Made: (If yes,date--------------------I No Q New Construction: Yes ❑ . Na FHA/VA: Yes ❑ NoA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer,is available within 200 feet.) d Septic T Ink: Distance from nearest well-----------------Distance from foundation_--._.-_.. � ; ' Material-•------- --------------------------------"•--- ❑ ��iS No. of compartments ----Size---------------------------- --Liquid depth---•----------------------Capacity Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line.......... ❑ gX�S�� Number of lines"-----------------•------------__-Length of each line-..-_---..---____-_--__�-----Width of trench.----...-----""-_ Type of filter material.-.------"--:"-- ... ------Depth of filter material-----------------------Total length.............................. ' Seepage Pit: .. Distance to nearest well_" 7f�_ Distance om foundation �.p.._.-_---.Distance to nearest lot line.-.�Q-`._ Number of pits-_0---- ---------Lining material----`-d•_C�K_-" Size: Diameter. 11 i ..Depth----,---------------------------- Cesspool: ------------------------- f Cess ool: rest well------ --------Distance from foundation-------------------"Lining material._ ..""-------------- P Distance from nea-•---------------- -----------Depth------------------ -----------------------•-=---._Li uid Ca Capacity gals. Y' Distance from nea q P ty------------------------"--g Size: Diameter"-""""" Priv rest well""""_..."- "-------------------------- Distance from nearest building❑ Distance to nearest lot line"""--...-""------- ----------------------- ------•"-------------- Remodeling and/or repairing (describe):---_----_ " r -------------"-------•---------- .------- -•---- ---- -..." -•----- ------ •----• -•--" ------ ---- ---------- -- ----------•• ---- •---- ... 1 hereby certify that I have prepare this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a d re lations of th San Joaquin Local Health District. � � f - -- --- ------I------- (Signed) ----- Owner and/or Contractor) 44 Plot len, showing size of lot, location of s ste in relati n to wells, """'(rile)"---_-._. d 4 By: . p 9 Y buildings, etc., can be placed n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----:-- ------__- ------------------- DATE-.---_ DAT --7....REVIEWED BY _. - — h--`--Z------ --------- ---- ----- ------------------------------------------------------------- ---------•------------------ BUILDING PERMIT ISSUED--.--•---------•------ — ---------- DATE.----- • Alterations and/or re c mme d'ations:__.___.."--__ . �,.."-.�. ...-."lam. : ••------- ---•--•---•-----•-------- •----•- ."" -----------•-------------------------------------------••-----------------.-------------------------------------- -•---------------•----•---- ------------------------------------•----- I FINAL INSPECTION BY:.---- ..�.------ Date..-----7---= 2 (u ' / f -------------_-_- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street J300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED 6-69 IM 8.61 ATLAS