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J ' {.-------- ----------------------- APPLICATION FOR SANITATION PERMIT ------ ---- ------------------- Permit No. --•----j 1 C) (Complete in Duplicate) ........... - -�-- -- ----- --�----� ---- --�-- � -- � �--�------�--- This Permit Ex fires 1 Year From Date Issued _ _ �—; _ Date Issued .------..._7-& L Application is Hereby made to the San Joaquin LvcahHealFh District for a permit to construct and in ` This application is made in compliance with County Ord; once No. 549. I stall the work herein described. JOB ADDRESS AND LOC TIO Z ..�.r: - --- -= . Owners Name------- --• ------. •-•-------- __________________________________________________________ -------------------------------- --------------- ___ ___________________________ Address_----..: _. y_.. ------------------ Contractor's --- P ....... hone._ Contractor's Name--------- •- ---•--•-----•------•---•----•-- -•----------•-•---•-•--------------- Installation will serve: Residence ---------------- ----------------------------------------------------------- r Apartment House --------------------- Phone................•- I ---•-------•-•••. ` ❑ Commercial � Trailer Court � Motel Number of living units: .1---- Number of bedrooms ___M Number of baths �� ❑ Other ❑ Water Supply: Publics stem. Lot size _._:. /Oa Y 'I[l �..ommunity system --•---------------------------------------------------- Character ---•---••---•-----•---• •- - -----•-----•---•------- Character of soil to a depth of 3 feet: Sand Private ❑ Depth To Water Table .r _R ft, ❑ Gravel ❑ 'Sandy Loam [] Cla Loam ________________) No y �IK❑/ ❑ FHA/VA: (] Adobe Construction: Yes No �—Hardpan Previous Application Made: Of yes,date____ 0 If TYPE OF INSTALLATION AND C : Yes ❑ No J� SPECIFICATIONS: New — (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well___T^ _---_Distance from foundation No. of compartments___---�- --------------- terial____.- Jle. ---- ----Size.-----3x_s __7C_- f Disposal field: Distance from nearest well__-:_` ...Lrquid�depth-.- _ - -------Capacity------ ----p--; .- Distance from foundat�on_/ _. ..•..--Distance to nearest lot lineIS'..__._•.. Etol Number of line __ -----------------Length of each line___,+Q-�- Width Type of filter materialG of trench___. -_ y - Depth of filter material_jB"_`'-- - eepage pit: Distance to nearest well--- - Tota! length A7-� ---- - Distance fry, foundation.1�-- -----Distance to nearest lot line_47Y ' Number of pits____-��--•_----_- Lining material_.____"-�_- Cess Cesspool: t ---.-Size: Diameter___JI °` p Distance from nearest well-------------- -Distance from foundation._._._._____- Depth--_--• cf�/ Size.- Diameter-_-____)_---- --__.Lining material____._---- ; --------Depth----- ----------- k,-------------11i Privy: Distance from nearest well------------ Liquid Capacity. els. -.-___Distance from nearest building Distance to nearest lot line------------------------ ---------- Remodeling and/or repairing (describe):-------------------- --- -------- ------------------- -------- ------------------------------ t •---•-----------•----------•-•-- - ---------------------•--------------------•--------------••------•-•-------•--------•------------------•----•--•-----••----•----•------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co ti ordinances; State laws, and rules and regulations A San Joaquin Local Health District. q u ty (Signed)---------------- - ---------------------------------------------------•---------------- By:.-----•-------------=------•----------•-•-_-•- 1 (Owner end/or Contractor) -- ------- ---"--- - __ (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., canbeplaced on reverse side). ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__-___ --._ 5 } REVIEWED BY l ------------------ --- DATE.... '---.�_ s�z..._- --•-•----•------------ ------ BUILDING PERMIT ISSUED.__.------•------ ------------ - DATE ------------------------•-- Alterations and/or recommendations: DATE •-------•--•---- ---- ----- ------------- F.� --•---- --- ---------------------------------------- ----- --- -------------------- ---------- ----------------- FINA INSPECTI $Y:------- --- ,. -.- –. ucv� ca� Date -- ------ --- F 130 South American Street USAN JOAQUIN LOCAL HEALTH DISTRICT ' 300 West Oak street Stockton,California Lodi,California 124 Sycamore Street 205 West 9th Street Manteca,California ES 9 REVISED 9-59 2M 8-b2 ATLAS Tracy,California 1 ems, -