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FOR O1F�CE YSE. ---- - ----------- -- ---- -_. . ..... ......... -_. - .t,�-�(�- -- -e APPLICATION FOR SANITATION PERMIT Permit No. _. �� ----------------------- -------------------------------- (Complete in Duplicate) Date Issued 3��2AP '---------------------- ----------------------------- --- is Permit Ex fres 1 Year From 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 CountyOrli. nce.No. 549. X? , 57 JOB ADDRESS AND LCPiON__ -s.- `� l /. 1 Owner's Name------------ rlk_ <_. . --`- --------------------- � --- ------•-•--•-•--------------------•--- Phone..--••-------------------•-•---..... Address* C� - a �.. -------•-••-... Contractor's Name.. ------+ �-------I` �--.. -----------------------------------------------------------------•------- ... Phone......--.-- Installation will serve: esidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: ___/--- Number of bedrooms-3 Number of baths d_. ot size ___ .. ___ls -_____________________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth To Water Table .419101t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe[2,+Yardpan ❑ Previous Application Made: (if yes,dote....................) No R New Construction: Yes ❑ No 1A/VA: Yes ❑ No�r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- r �)(j5i�l No. of compartments------- -----------------Size--------------------------------Liquid depth---------------- ---------Capacity...-------------------- Disposal d: Distance from nearest e1I______.____..._.Distance from foundation___�__P .____Distance to nearest lot line---- IGmber of lines- _____._. ._.__---------------Length of each line------_ �__ -------------Width of trench . -� ............... °�ll�°. ype of filter materiaL�CQ :: _-----Depth of filter material_-- __f_..._Total length-------r---- -------------=----------- Seepage Pit: Distance to nearest well................"°__'.Dis"tance from foundation_..y['.V. .__..Distance to nearest lot line.ter___/.___.- _---_____Linin material__ ,___. Size: Diameter.._.___ Depth [� Number of pits. ------------ 9 '-�"_---- -- �--- �-----�------. ---------`��•--=---------- d Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Linin g material--------.-----------................ El Size: Diameter---------------------------- •- - --� •-Depth-___.__-.-__-_____---------- ------------ -- ----.-Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------- -----------Distance from nearest building__________.__________--.----..._--.___-.-. . ❑ Distance to nearest lot line`--- ----------- ----------------------------=-•------------ -------•- --- ------------ U Remodeling and/or repairing (describe):-----------e- ------------r.�[�e�'= IA l ,�.y1 ----•-== --------------------------------------......------•--- --------•--------------------------------------------------------•----•--•-------------------------•-----------------•--------•--••--•------------------------------- ;-.. --------------------------•---•-------..----------------•--•-----•-•-------••----•----------...------------------------------------------------------------....-----------•----------.-----.-----------••--------------------- hereby certify that I�rav�prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ,ul hand regulations of the San Joaquin Local Health District. (Signed) __ _ (Owner and/or Contractor) By----------------------------------- ----- ----- •-•-..••----------------(Title)- -------------- (Plot plan, showing size.of I , oca+ion of system in relation to we s, itigs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ----------------------------------- -----------------•------------•--- iREVIEWED BY-------------------------- •------------- - --- -=-------------•---------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------- -- --- _ DATE- ----------------------------------------------- AFtera+ions and/or recommendations: - ----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ -------------•----...----......--•----•--••-• ------------ ------- ----------------------------------------------------------------------------------------------------- ----------------------------------- --------------961t - - ------------ -•- ----------------------------------------•--•--------•---- ._.-------- •---- ............. FINAL INSPECTION B - --- ------ -- ------- Date ..... ----•--------------••--- AQUIN L AL HEALTH DISTRICT 130 South American Street 30k Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E& 9 REVISED 8-59 2M 5-62 ATLAS