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FOROFFICE E: i NO=- -------------------- --------------------------------- ! APPLICATION FOR SANITATION PERMIT Permit No. _4&1 -------------------------------- •---------------------- (Complete in Duplicate) ! I This Permit Expires i 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.-- r This application is made in compliance with County Ordinance No. 544. `r ! JOB ADDRESS AN OCATION------- ------------ o~L � Owner's Name---- _._ c>=qG - --------------------------------------------- ..................... Phone_............. Address........... Contractor's Name-------.__-je��.._._ a -- -•-•--- Phone-...........•..__....__--._.-_ Installation will serve: Residence [-] Apartment House ED Commercial C:] Trailer Court ❑ Motel ❑ Other 131--jW Number of livingunits: _ `< r ____ Number of bedrooms ..,.. Number of baths __1____ Lot size ___ - l"„ _ -----•----------•- Water Supply: Public system 9--tommunity system ❑ Private ❑ Depth To Water Table _7ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ f Previous Application Made: (If yes,date--------------------) No.�New Construction: Yes E] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: p (No septic tank or cesspool permitted if public sewer is available within 200 feet.) N Septic Tank: Distance from nearest well_4r!_ ------Distance from foundation•/_0-----------Material [? ---- 3�_/.0 , — 0� No. of compartments------Zl----•------Size___ `(e-X--4C.D----Liquid depth-----L-I -----------Capacity---- Disposal a aci Disposal Field: Distance from nearest well--:V--`- Distance from foundati n.__ -jQ...__.....Distance to nearest lot line._ --- r - I I� Number of lines-----1_. •------------------•---Length of each line___ W-_----------------Width of trench.. e _5E-. ------------- Type of filter material._YQ- ------Depth of filter materia`t__t-�'�--------Total length___.-P�_11 „---------------- `e� See�pa,/ge Pit: Distance to nearest well---__� ---------- lrt� Distance fr m fo ndation____ �� _.__-.Distance to nearest lot line___c.S`�_-- I!I' Number of pits------I__-____-__--Lining material__ I -Size: Diameter._ ` .e Cesspoo: Distance from nearest well--________-----Distance from foundation_---____-,----.❑ Size: Diameter. - DepthLining material.___.________________ ___ ----------- I - ----------------•------------------------Liquid Capacity- --------------- --------gals. Privy: Distance from nearest well-----------------------------------------..-___--Distance from nearest building El Distance to nearest lot line._.-____._-- Remodeling and/or repairing (describe)---- ----------- ------------ ---------------------------- ---------- tom— ----------- --•----••-------•-------------------- =---------- ------ - I _ .__/____.. _•_tee_ ______________________________ ___________________________________________________________________________________________________________________________________________________ _____________________ ___ _ _____________________________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, State I and rul and 1regulatio of the San Joaquin Local Health District. I (Signed)------------- ----- • ---------7, a �------ ----- _ -----(4+ er Contractor) By:------------------------------------ ��--1.� [r+lel _L__.___- - _ .. .-.__ _�ry - _ x {sem.. »_____________ -_-_..__-------_---____-..__- (Plot plan, showing size of ior of system to relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY_-__. ----- _ ----------------------- DATE_J/77_7_-3.-- - VlEWEDBY--------•------------------------ ---.. DATE----- ---•--•--•------•------------------------------------- Alterations ------- ----- BUILDING PERMIT ISSUED_________-- •' ••-------------- s:--------•---------- - - -------------------•------------------- DATE.------•-----------•------------------------ --- •--------- Ai'Ferations and/or recommen ations________________ ------ •- f` ----- •------------------------- -•-•---------------• ....... -------------•-----------------...-------------•-------------•------------------------------------•- � -------------------------------- ----• -• -------•---------------------------------------------..-----------•---------------------------- ------ FINAL INSPECTION BY:---- -- -_ -- ------ ------- ------- ---- Date-- 2- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street l 300 wed Oak Street 124 Sycamore Street los wait 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS I