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FOR OFF E U S I .. jj fC -----_ :3.�r APPLICATION FOR SANITATION PERMIT Permit No. ..... .._. ----------------------- .------------------ ------------ (Complete in Duplicate) Date Issued ------------------------ -------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance N . 549. t JOB ADDRESS AND LO ON....... -2- Owners Name. --- ----- ----._ Phone! Z_._o -fl- a -� 7 Address------------------�/��1 +-..•_. ----- ------- - • ------------------ .......................... ................... Contractor's Name--- / 'f ..r- -4 . I......................•------ Phone --....ZJ ---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 9 i Number of living units: .. ___ N tuber of bedrooms ..Number of baths __L. Lot size s=�5 ___.4 -------------- Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table ft. Sandy Loam Clay Loam Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 5a y ❑ y ❑ Y " Previous Application Made: ilf yes,date--------------------} No ❑ New Construction: Yes ❑ No P-_*'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) ti Distance from nearest well_________________Distance from foundation-------------------Material-------------------------------------------------- No. ____-..-_____----___ _No. of compartments-----------------•--------Size----------------------- Liquid depth------------ -------------CapacitY-------•-------- •----- pp . �^ D• a ehd: Distance from nearest well_�zylr`_,,.=Distance from foundation__.�.0--_...Distance to nearest lot line__..C�........ 1 Number of lines____•____/___________________�'_Length of each line Type of trench___Z'�'��.-----------.- C�[� /1 f Type of filter material.' --Depth of filter material l_ _ Total length......... _____________________ Seeps a Pit: Distance to nearest well_f-k:' _ ___Distance om foundation-- oundation �.________-Distan;e to nearest lot lin e__._____..... Number of pits___ _________________Lining material___ .l1.C "__-____Size: Diameter- ----Depth_____--�_�___.......... Cesspool: Distance from nearest well__________-_--.-Distance from/Jfoundation---_---------------_Lining material---..___.______-_-______....._-_____- ❑ Size: Diameter--------------------------------------Depth.---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well__-__--__________________-____---___-_-_-__.--Distance from nearest building---------------------------------------- i ❑ Distance to nearest lot line---------------------- -------•-----------------------.-_-------•----------- ---------------- ` Remodelingand/or repairi g (descn ):---------------- - ------------------------------------•-•----------------------------•- ------ ----------.....----------------••-•---------------- ------------•--------------------------------------------------- ---------- ----------------- ----•---•-------------- ..--------------- --------•--•••---------------------•--- r j - ---- --------- -------------- --------------------------------•-----------• --- --•----------------- --- - _- -- hereby certif tha v pr pared this ap i tion and that the work will b done in accordance with San Joaquin County ordinances, S s d regula ' ns of the San Joaquin cal Hea strict. , (Signed)--��-------------- ---- �"{ '"�T--• --- -- �✓f �- (O;rr rr�.�fj�r Contractor) By: ---------------------------- - --- (rifle)----------------- ------------------------ --------------- ------ (Plot plan, showing size of lot, location of system in ation to wells, buil ngs, etc., can be placed on reverse side). ` FOR DEPAjRTMENT USE ONLY APPLICATION ACCEPTED B? - ------ - --- - - - ----------------- --•-----------•----•-- DAT -- .. _. --------------------------- REVIEWEDBY----------------- ------__------------------------------ ---- - ------- ----- DATE BUILDING PERMIT ISSUED.... -------------------- DATE..--- •------------------- " � Alterations and/or recommend tions: ..__-r'.._ _0 ----- �0-.&3_. - ------- ----- ----- t4a_ '--------------------------------------- ------------ ---------- ------------------- `� -... -------------------------------------- --------- - -- - ----- 1 -- - ;7?n---I--------- s —� 3 ------------ F1NAdINSPECTION BY-------- ---------------------- ------ - ------ Date_.-------------------- -------- SAN ------;SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mafiteca,California Tracy,California E5 9 REVISED 8-59 2M 5-52 ATLAS