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FOR OFFICE USE: ___----"----- ---------- "-_- _._..__..____--_. APPLICATION FOR SANITATION PERMIT Permit No. rz2l ------------------------------------------------- ---- -- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to ons yct and install the work h sin described. This application is made in compliance with County Ordinance No. 549. /f�q Il 2 7 0 1 r JOB ADDRESSD LOC TION_..--•-------------------------------- --- Cl--_ Owners Name - --a•--llr2 .. .•-• --- ------------ Phone--------------------------------•--- Address - •1.3.a. '•---A�---- ----•---------------- --•------•-•-------------------•---------------- -- •--•- Contractor's Name,_. ---•-•-----------•-------•------------•------ Phone...�9 3.7 3ZPI_ Installation will serve: Residence (� partment House ❑ Commerce Tr Co ❑ Motel ❑ Other ❑ i 2zS X Number of livingunits: __ Number of bedrooms .-�___ Number of bath ..I Lot a ______________________ Water Supply: Public system ❑ Community system ❑ Private CQ Depth To Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Q Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ® No ❑ FHA/VA: Yes ❑ Noli:J . r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) "v 1 ! / Septic Tank: Distance from nearest well__.___.--_---Distance from foundation_____-/Q------Material__________ ___ ® No. of compartments_..__-.Z--------------Size—Kk_/#'94r /A`r Liquid depth____ .......Capacity----- .4 Disposal Field: Distance from nearest well- -Distance from foundation...../0 .......Distance to nearest lot Number of lines________ // 2------____-/ Length of each Iine;�Q--�� 17__.Width of trench-------- ---�--------------- Type of filter material__. ----------Depth of filter material ____If_----------Total length------------1512_________________ Seepage Pit: Distance to nearest well----�IQQ-___-------Distance fro foundation___74_-___.__Distance to nearest lot line $-______.._ Number of pits )Z.__._______.__Lining material_ Size: Diameter_-3�{3_.__...___.Depth_____2_S_________________ Cesspool: Distance from nearest well______________-_Distance from foundation--------------------Lining material__.____._________-__-__-___________ ❑ Size: Diameter--- '----------------------------Depth-----------------------•----------------------------Liquid Capacity----------------------------gals: Privy: Distance from nearest well-________________________________________ _______Distance from nearest building______-____________________.______.___. ❑ Distance to nearest lot line------------------------------------------------•---------•-•------...----•----------------------•---••------__-•----------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------- ------------------------------------------•---------------------------------------------------------------....---------------•----------------------------------------•---•---------------------------------------------- - I 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 of the San Joaquin Local Health District. (Signed) q ---------------------------------------------- ---------------------------------------------------------(Owner and/or Contractor) By?c_ ------------ ------------ ------------------------------(Title)------[rr t.------------------ (Plot plan,'showing s e of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B _ ____ DATE.._ REVIEWEDBY--------------------------------------------- --------------------------------------•-----------••-----------_-- ----------- DATE--------------------------------------- ... BUILDINGPERMIT ISSUED--------------t-----------------------•-------------------•------------------------------------------ DATE------------------------------•----- •--------------------- Alterations and/or recommendations--------------------------------- ----------------•-----•--....---------••----•--••-•------...----•-••-----•--•-•-----•---.....-----------------••------------ - --------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------•------------•-------------------- ------ FINAL INSPECTION BY .- ---- --------------- Date-- �9 �F 1 U� # SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wist Oak Street 124 Sycamore Strut 205 West 9th Street Stockton,California ti Lodi,California Manteca,California Tracyr California ES 9 REVISED 6-59 2M 5-62 ATLAS