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am-b Z l• _ _ ;. --------� -1 --------------------------A-{ APPLICATION FOR SANITATION PERMIT Permit No. ..... ).''t ------------- ----------------- -------------- -- ------ (Complete in Duplicate) ...... - --- ---------- This Permit Expires I Year From Date Issued Date issued __r Application is hereby made to the San Joaquin Local,Healfh-District for a permit to construct and install the work herein described, Thisapplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCA T ---Z. ------ 00;------------- ......................----------------.....................------------- Owner's Name- _-- - _----- ----- Phone_.......•.................... Address _--------- -•- -- --------- Contractor's Name------ Phone..........._ ---•--------•----------------••---•-----•---- - -------.........- Installation will serve: Residence 'Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms--. Number of baths/ Lot size _ -.� �- Water Supply: Public system ❑ Community system ❑ Private &�Qepth To Water Table ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes Wk'No ❑ FHA/VA: Yes P--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta : Distance from nearest well_. -_Distance from m foundation---�-f�___---__--Mate�a!_�_6 - -----------•- 9?11 No. of compartments-_`�_-�"_-:_-_.Size��___X-Cy/e�Liquid depth----- �� -Capacity Disposal Field: Distance from nearest well-�-------Distance from foundation_.__ -. ��_-.--------Distance to nearest lot line ...... i i Number of lines_______________ - -_`__.�Length of each line--- Width of trench-,�-__.-____----,.--___-________ ��"" Type of filter material. Depth of filter material___ � ------Tota! long#h._ --.....__ Seepage It: Distance to nearest.well--- ---Distance fr m fou9dation___�0__.____.D• tante to nearest lot line-%I-'o....... Number of its---: --- " t p- -------------Lining material-. -.$ize: Diameter,--_------_-,Depth_*24.7�_-_-----_---_----_ Cesspool: Distance frorn' ne est'well------ --------Distance from foundation---------_-------.Lining material_------_----------_....-_ ❑ Size: Diameter--------------------------------------Depth------------------------------- ---------------------Liquid Capacity--------------------------..gals. j Privy: Distance from nearest well------------------------ _-----Distance from nearest building Distance to nearest lot line------------------------- ; ------•-------------•---------•------------------- .Remodeling and/or repairing (describe):---------- -- - - -------------- -----------•---------•----••----------------------- -------------------------------- ` ••---------•------------------•----•--------•---••---•----------------•----- .__ _ -------------------------------------- -------- ------••----------•-------- ------•----------- - -- = - " :-. PM._ ="- -=-----------•---------•--------------•----------------- ---•------------------------------- j 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 regula�tiLris of the San Joaquin Local}Health District, (Signed)--------�r/-6-46✓---- , ! ------- .............. � C tr t -- -- -- 1 r on ac By:----------`-----••--------------------------------------- Tie / �- or (Plot plan, showing size of lot, location.of system etiori,towells, buildings, etc., can 6t3.placed on reverse side). x" FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ___-__--' -- -- - -------------------- DATE----Il-- _-_I-_`�---------------- ------- �-- �- EVIEWED BY----------------------=--------------=----------- ---------------- --------"-----------'--�--'------------------•------- DATE----BUILDING PERMIT ISSUED - _ N-- - - - ----------------- DATE----•-------------------- -- Alterations and/or recom 'end do s.----_ - 1 —--------- -- -- - - --------------- ----------- - --•------------- _ � - ... r� --- -- - ---------------r-------- ` - ----------- --- f = = f Y = ' ... .... ......= _ - 1 ------------------- -.- FINAL INSPECTION BY:. .-.r .-- ---- Date------/ -- h:--.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Strut 124 Sycamore Strut 205 West 9th Strut Stockton,California Lodir California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-52 ATLAS / f.