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FOROFFICE YSE, ................ --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .......... .. ...` ----------- --------------------------------------------- (Complete in Duplicate) /'"/ / ----------------------------------------------------.--- This Permit Expires 1 Year From Date Issued Date Issued ...........��.�az 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 , a once, A�;549. ` l fyC. ` /� I� J08 ADDRESS AND LOCATION___r . . ...4--7�V { / � --' _ -- - - ------ -------- ---- Z c �.. _. ......__.... Owner's Name--- ------------------------------------------ Phone.- Address....... `'� !------- - Contractor's Name-----P- 4 -- --- --------------------_---.........•--------------------------•-•------•------ Phone.._................................ Installation will serve: ResidenceE] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: -1------Number of bedrooms ___2-.Number of baths ----I--- Lot size ___ ✓ ___?S____1..' ___________________________ Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table sS. . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [3 Adobe EY"-Hardpan ❑ Previous Application Made: {If yes,date____________________} No E] ' New Construction: Yes &—No ❑ FHA/VA: Yes ❑ No [i]- ' 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.... ..-_....___. No: of compartments-_________`Z--------Size._•�_X_ depth..... ..._____--_Capacity__0-0 j.- Size--- Disposal - --� f :2 pis osal Field: Distance from nearest well-��___Distance from foundation_Lh.�_r..��is#ante to nearest lot line _•�•.�:� Js' Number of lines___________________I---------------Length of each-line-------- _2____. of trench-------- -. ......_ _.....__ Type o£ filter material._._ �.1CDepth of filter material_______l .f`)_.__Total length------- .P.`_____________________ l�r'1 /-f- -� G Seepage Pit: Distance to nearest well___ r __Distance„from foundation__..1 ------------ -__:___..Distance to nearest lot - 10 Number of pits---------- -----------Lining material--- � ----Size: Dia meter-____�3---------.Depth-----'J_.4..._--_------------ f 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 loft line-- ---•------------------ ------' N. 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 I ws, and rulZ and regulations of the San Joaquin Local Health District. (Si ned /( 9 ) x... T A-� Y�r:z 1 --------------------- ------------------------------------------------------------•- -------------(Owner and/or Contractor) By:.................•-•----------------------------------------------------------- ----------------------------------------------------(Title)---------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - .-- ------_-------------------------- DATE- f REVIEWEDBY------ ------------------------------------' -------------------•---- ----------------------------------- DATE............---------- BUILDINGPERMIT ISSUED------------- --------------------------------------------------.------------------------------------- DATE----.....__.... Alterations and/or recomma atiiotts-------------- - --- . ----- r ------------------------------------ •-------- ------------------------ ------------------ FINAL INSPECTION BY:..-----v � ��-�w Date.--•-r - -r�---.5--A...� -------------•--•------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sweet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 5-59 ZM 3-61 ATLAS "�•,.r ��