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FOR OFF�C U� = Permit No. �W...�:�. . -:�--..--- __ J � APPLICATION FOR-SANITATION PERMIT - ----------------- ------- -------------------- (Complete in Duplicate) �i - Date Issued ....__. ...-- ----------------- This Permit Expires 1 Year From Date Issued �3 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. x' JOB ADDRESS AND LOCATION....,, 3Sr-------- ---------- -------- ---• - Owner's Name...-52�-�._ enp ------------ ------------------- Phone..,4./O:�3 Address--------•-••-----�� ----••-----------------------•-••-------------------- ---------------------•------------------------ ..........-...................................... ... Contractor's Name---------- ------Ic - - � -�-<'=---•---... Phone.. _...__ Installation will serve: Residence a Apartment House ❑ Commercial !❑ {Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/.... Number of bedrooms ..1- Number of baths ._/___- Lot size ...... ......9_1._r.3_Z..t------------ Water Supply:. Public system [I Community system ❑ Private,®' Depth To Water Table% Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E].. Clay Loam (� Clay Adobes Hardpan E] Previous Application Made- (If yes,date___________________) No New Construction: Yes ❑ No W FHA/VA: Yes ❑ No3- TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material..--_________-_-________------.-___-._-__--____. ❑P, l No. of compartments-------------------------Size-------•------_---------------Liquid depth-------•------------:-----Capacity--------•-----•------. Disposal Field: Distance from nearest well..%0_0-------Distance from foundation__.-.. /O...___Distance to nearest lot line____ 1j) Number of lines------------/--------------------Length of each line.------- __._...._____.Width of trench--------- ct Type of filter material._. G/4____-Depth of filter material------�/�_'_____Total length_________________________ -------- 1cJJ�► Seepage Pit: Distance to nearest well------/D6_!___..Distance from foundation......14.__....Distance to nearest lot line......S___-_ Number of pits--....__/------------Lining material--- --- Size: Diameter------� _--------Depth------------------ -------- OLX Cesspool: Distance from nearest well_________________Distance from foundation---._.___ _-______.Lining material----------- ID Size: Diameter--------------------------------------Depth-------------- -------------------------------------Liquid Capacity------------------ ... gals. Privy: Distance from nearest_well-----------,�----------------------------------Distance,.fro nearest building-------------------------.---------------- ❑ Distance to nearest lot line----------------------------------------------------------------------._.....-------------------------------------------.------------------- A Remodeling and/or repairing (describe)--------------- _G ------- -- -•-------• 3 ---------- ---------------------------------------------------------------------- --------------------------------- •--------_____________________________________--------------------------Y---------------------------------- ------------------------._.________ _ ___._._______._.________________._________________.__.._ ____________________________________________ ____________________ . ___ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and -regulations egulations of the San Joaquin Local Health District. (signed) ,� re w `°,—: s (Owner and/or Contractor) --------- BY:-_---------- ------��-�� -----------------------------------------------------dr+le}_.. ----------- --- (Plot plan, showing size of lot, Iota+ion-of sy0em in relation to wells, buildings, etc., can be placed on reverse side). R DEPAR EN SE ONLY APPLICATION ACCEPTE - ----------------------------------- DATE- - '_.. _.s ----------- ---- -- - ----- REVIEWED BY------•----t--"--------- - ------- ------•-•-------- DATE------------- -----------------------------•--------------- --• -------------- ---------------- --------------- BUILDING PERMIT ISSUED-----•_---------- ----------- 0 and 0 --- ----- - � -..._.. ------ ` ---------------------------•------------------ ------------ -- --- ----- ----- , ------------------- -------------- -- ---------------•------------------- -------- ------- ------------ - --------------------- ----------------------------- - ------- -A _ ` � .� y FINAL INSPEQI0N BY.----------- -- -•-- ------ Datea�-- ---------- ------ ---- SAN JO N LOCAL ALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California Manleca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS