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FOR OFFICE USE: --------------------------------------------------------- J -----.------_-_---_---_-----_-----------__-_----- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------- ---------------------------- (Complete p e 1 Ye Duplicate) /G2� t p From Date Issued Date issued ------------- -- --- om This Permit Expires _ _..__ - �� 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 complianc.� it -County Ordinance No. 549. Z ks�•U�U • 77�£�"�t E,�J JOB ADDRESS AND/LOCATiO �Z�C' r 'fi-'L -.. Owner's Name----./ __ -- - -- - ,�f�-'. .. ------ Phone........ Address__. r� -•--------••-•----• •-------••-------------------------------------------------------- Contractor's Name......1 ._7._1i:•11"___1 .........--••---. --- ---------------•----------••---- Phone................................... Installation will serve: Residence b? Apartment House ❑ Commercial ❑ Trailer Court ❑ .Motel ❑ Other ❑ Number of living units: J____ Number of bedrooms _3____ Number of baths .a--- Lot size ---3'-'v o i 3 00 Water Supply: Public system ❑ Community system ❑ "Private M Depth To Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loamz Clay ❑ Adobe❑ Hardpan Previous Application Made: (if yes,date--------------------i No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ N 0 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__�---------Distant from foundation----,fA---------Material...__&I, ' ...............•___.. [ J No. of compartm __ents_ -------------------Size . t'U' f---r-- Liquid de th_..'Y_.__...___-_-.-_Ca aci _/ _. Q Disposal Field: Distance from nearest well___a ......Distance from foundation....IV---------Distance to nearest lot line....r�-___----- Number of lines________' _-__ ------------ Length of each line------ -----------Width of french___ c_`�_V---------------_-- ------------------------- h? ____________-- _-- T e of filter materia �p�,J Depth of filter material. �_�_ ---------Total _________________________ YPfF` Seepage Pit: Distance to nearest we I_/Q ---------Distance om oundation___Z0---...___.Distance to nearest lot line__._.._._ P0Number of pits--�--------.------Lining material-- -----.-Size: Dia meter__..J.3---------Depth-___, -5"'................ 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----------------------------------------------- •--------------•------------------------------------------------------------------------------ x Remodeling and/or repairing (describe)-------------------------------------------------------------------------------------------------------------------------------........................... --•-------•----------------------------------------------------------•--------•-----------------------•-------------------------------------------•-------•--------------------•------•------_------------•---------------- ' ---------------------•-----------------------------------------------•--------------------•-------•------------------------------•---------••------------------------------------------------------------------------ - 1 hereby ce if that I have p Dared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rule d gulatios the San Joaquin Local Health District. (Signed)------ - - - - ---- ---------- ---------------------------------------------------------------•-------------------(Owner and/or Contractor) By:-----------_--------------------------------------------------------------------------------------------------------------------(Title)--------•- - ------------- - -------------- (Plot plan, showi size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �- -` � APPLICATION ACCEPTED $Y� - - - --- - ----- ----------------------------------------------------------- DATE---- -----_7 7 ------- ---------------------------------- REVIEWEDBY---------------------------------------•------------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED_-------------------------------------•--•----------------------------• ---•--- ---------------- DATE------------------------------------------------------------- Alterations and/or recommendations-.,-.-------------------------------------------------------------------------------- --------•--•-••-•-•----------------------------------------------- ...... -----------------•------------------•--------------------------------------------•-----------------------------------------------------------------------------------•--------------------------------------•--------------- FINAL INSPECTION BY-,,--,- --------------------------- Dafe._ZA._-ZY-4 Z_-__-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street w 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS i