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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.------------------------------------------------ ..j`7 fl.< --------------- -------------------------------- (Complete in Duplicate) Date Issued _......................___._-_.___._____________._-. This Permit Expires 1 Year From Date Issued ----- 015(- 140— Application Z is hereby made to the San Joaquin Local Health District for a permit to construct and i s# l�l�the worherein descrl ed. This application is made in compliance with County Ordinance No. 549. lee .Tv, dwo 0!/�t�p�� Q� O JOB ADDRESS AN LO ATION-./C�1--/.-.9Q7C-��i-,1--,-�� Owner's Nam ----- -e27 ----------------------------- Ph Address..,_..P.. •------- --------- ------------- �- - -----------------------------------------•- Contractor's Name+___. . . _. _aJ�_-J`-- _ ------------------------------------ Phone,//v Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---4. Number of bedrooms.. Number of baths J_ I t size =------------------------ Water Supply: Public system C] Community system C] Private 0,-Erepth To Water Table 6.64t. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No + FHA/VA: Yes ❑ No ❑ TYPE 'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Lit i Distance from nearest well-----------------Distance from foundation--------------------Material-----._-----_----_._-----___-----•_-----_-.-__--. No. of compartments--------------------------Size---------------•----------------Liquid depth--------------------------Capacity------- o�5e Distance from nearest well -�--Distance from foundation-.p1 0_�-Distance to nearest lot line....�Q--�� Number of lines___-�-- ---__ .+___. . Length of each line_______ _Q. ._ . Width of trench-- -jL �__ Type'of filter material. Depth .of filter ma erial_____ __ ___ .__-- - Total length-- -_ j Seepage Pit: Distance to nearest well-_/00......Distance from f undatio�.Q-_.Distance to nearest lot Number of pits----�--------------Lining material__) ._ __...Size: Diameter__��-_-___-Depth_--_ _ '_----___---- Cesspool: Distance from nearest well-----------------Distance from oundation--------------------Lining material----------.______________________._._ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------9als. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building----------____-----_------_-----_--------. C1Distance to nearest lot line--------------------------------------------------------------- ---------•------------------------------•------------------------------------ Remodeling and/or repairing (describe):------ --- ------•---- ••.--------- - -------------- ------------------- --•--------•-.......... ..............I.........-.---------- --.�.- ------ - -.--- ------ Q- ---------------------------------------------------------------•---------------------------------------- ---------------------------------------•---------•- ------------------------------------------------------------ --------------------------------------------------- --•----------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Slate la and rules an regulations of the San quin Local Health District. (Signed).. � -. 1(_ U c. Contractor] r --- - By-------------•--------------------- ------------------------------------------------ {Title)------------- -------------- --.........I ------------- (Plot plan, showing size of lot, location of system in relati to wells, buildings tc., an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - ---------------------------------------------------------•-----•-j<......0--•--=DATE-•-------- REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------- ... DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------------------------------------------------------------–------------x------ ------------- DATE------------------------------------ ------------------------ Alterations and/or recommendations:----------------------------------------------------------e............ '...-------...----....----....-----•----------------------------------••-•------.- d ----------------------•---------•---••-----------.---.----•-----------•-----------•-----••---------•---------------'---------•-------------_---I..............----...-•----•-----.........-----------•-•--.....-•--------•--- ---------------------------------------------------------------------------------------------- ---------------------- •-----.----------------•-----•----------------.--------••--------------------------------------- ------ b -----------------------------------------------------------------------------.._.___------_-__.------...__..--..-_..---_-_.-----..---_---_-_v__--_---_-_.---------------------------------.------------------------------------ FINAL INSPECTION BY: ------------------------ Date--/,9-_. ------------ --------- ----- -•------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak strut 124 Sycamore Street 205 Wast 91h Street Stockton,California lodlr California Manteca,California Tracy,California E5 9 REVISED B-59 2M 5-62 ATLAS