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FOR OFFICE USE: 3. ------------ --------------- - -= .__.._____._ - -------------- APPLICATION FOR SANITATION PERMIT Permit No. .LU66,� -------------------------------------------------•------ (Complete in Duplicate) ----------------------------------------------- ------ --- This Permit Expires' 1 Year F ,-_rom Date Issued Date Issued 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. 5". _1001/11 JOB ADDRESS AN LOC ! --------------------- ------- r_.._.. L � �y..�. ®...... Owner's Name --- - ------ - ------ - - - -- -------• -•---------------- Phone.,i---�'.:..jzlAddress 3 < .... Contractor's Name---------------- -------.-----------•--------•------ Phone.------..............------ Installation will serve: Residence If Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._.__. Number of bedrooms - __ Number of baths __ Lot size _.I A?_-3_X_-~ a_0-________________ Water Supply: Public system ❑ Community system ❑ Private- Depth To Water Table . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe FIA Hardpan ❑ Previous Application Made: {If yes date____________________I No } New Construction: Yes [N' No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weJ___6�.__._Distan*-cue fro undy�{ion__1�____.___m t iai___ r__.___ No. of compartments-----�----------------_Size-47. ��.-�-._-.Liquid depth---------,---- ----_---_-Capacity_-,f��-04 Disposal Field: Distance from nearest well ....Distance from foundatio .-/-2- ....Distance to nearestI� j____'_ �I t �e�r.___..... Number of lines ___._��l_____ __L ngth of each line._�U�_ � Width of trench. _s`�>�--C_______________ W Type of filter material ._.__ __ __ epth of filter material__ .___.____...__Total length_.-. -�_____________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits----------------------Lining material-----------------------Size. Diameter-----------------------.Depth__--------------_----------- Cesspool. epth_ _--•-----------••--------•-- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- El 'Size; Diameter-A---------------------------------Depth-------------------._..-----------------------------Liquid Capacity-------------------_.......gals. Privy: Distance from nearest well________________________________________________Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line - {Q Remodeling and/or repairing [describel------------------- - ---- - -- r t........gil/--•LL2-.-�1�------f[......_. ,V P ��`s U '� ` ', ---------------•-------------------------------------`----------•---------- ------- O I A 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 re laf ns of the San Joaquin Local Health District. t (Signed) !/ - ......... ....... -----------------•-------------------•--------•-------------------(Owner and/or Contractor) By: (Title) ------------------ E (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........ �--�--�-r�--- -- .��------------------ REVIEWEDBY-------- ------------------------------------------------------------------------------------------------•--------------------- DATE BUILDING PERMIT ISSUED------------- � ,4 -.... --------- ATE------Alterations and/or recommendations: , tsr lr -_---ctie �: �- ___________ _______ f-�"A+4¢Y-..___.___.' _`�/ __ ..___.__...�/�/�?(�+ .lF_- y-______. ir=iv•• _.L"'!_tlC:___ �i�if �!�f =-71. .._._ __.___' / ------------ /��__---_---ih...�_-J _.__.--- 2�7 .4_------------1- � --------_---•- /V1 T- ----- •--------- ----------------------_----------------------------------------- ------ ----------------- ------ ------•--------------------------------------------------------------------------------.-...----------- FINAL INSPECTION BY:----- =G � �:_ _3 Date -- -L-- Cb ---------------------------------•-•----•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Strut 205 Wast 9th Street Stockton,California Locil,California Manteca,Callfornia Tracy,California £S 9 REVISED 8-59 2M 5-62 ATLAS