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F RO EU4 / -7 5 Y _-n APPLICATION FOR SANITATION PERMIT Permit No. ........................ - ------------------------------------------------- (Coi'nplete in Duplicate) �~ - This Permit Ex .ires 1 Year From Date Issued Date Issued ..... 3 ------------------ 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. 549. JOB ADDRESS AND LOCATION--• -------------------- ------------ ------------- ------------------------------------------------- =- Owners Name--------------- _ 1. i12 �C�T----•----------------------------------• ----------------------:------ Phone /, ' .x ------ .dress i ------- Phone.Contractor's Name...... --•=--•-`--•--•-• --- --------•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ;,,Mpfel ❑ Other [] Number of living units: --- --- Number of bedrooms _ . Number of baths .Y Lot size ------- =------------------------------------------- Water Supply: Public system: ❑ Community system ❑ Private Ek-115e-pth To Water Table _7A ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ` Previous Application Made: 11f yes,date--------- ----•_`1 No New Construction-. Yes E111"No ❑ FHA/VA: Yes 21---No ❑ t TYPE OF INSTALLATION AND SPECIFICATI8N9:k I. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q --------.Material-- - ------ :.�. Septic T nk: Distance from nearest well__--__Distance from foundation____...P No. of compartments--------.. -_,---Size--------------------------------Liquid dept...._. Zf-------------Capacity../-_r_-•__-- `. Disposal Field: Distance from nearest well.---_:__0-----Distance from foundation-----/. LJayDistance to nearest lot linp.___.- .... Number of lines_______________lot I Length of each line4i_ rc-� Alidth of trench_._ _ -. Type of filter material._._ _ _° -_:De Depth of filter material____fe-.-_________Total length-------- _ _____________________ -- p - - Seepa Pit: Distance to nearest well----lk' `__Distance from foundation----f-../--------Distarce to nearest lot line f.... LL.,. Number of pits______- -----------Lining material___1 �`�.___ ..Size: Diameter____ _ _____________Depth------ .__.....____.__. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------ El Size: Diameter--------------------------------------Depth--•------------- I-------------------------------Liquid Capacity-------•-•--•----_-•------gals. Privy: Distance from nearest well_______________________________________________ _Distance from nearest building------------------------------------------ Distance to nearest of line__.__-�- ❑ ------------------ ---------------- - -------------------------------------------------_----- --------------------------•-------- -- - - - r � Remodeling and/or repairing (describe)-------------- ?---- ------•----..-------------•-••------------...----------------------------....----•------------••------........._..------••-------- 4 •------•-•----------------------------------------- ----------------------------------- i" t hereby certify that I have'prepared this application and that the workowill be done in accordance with San Joaquin County ordinances, Stat I ws t_ les d g-yl ions�o �e San Joaquin Local Health District. II e o (Signed)-- - ------- -•--•--------•------- ----------------------------------------------------------•- --------------------------(Owner and/or Contractor) -- ---- - --- -------- ----- ------ (Title) ........ (Plot plan, sho ing size Q# lots tt h to wells, buildings. etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ----------------------------------------- _________ . DATE ----- - REVIEWEDBY----------------------------------------- - ---------- --------------•------------------ ------------------------------- DATE--------- ------. ----------------------------------------- �,+ DATE------;� BUILDINGPERMIT ISSUED-----------------------••-•-- - ---•------- ----=-:------- ------ - -------------------•--• --._...----•-- --- Alterations and/or recommendations:___�-__._--.--- �� -. --•-----• , Gel ±' _... LZa 40V r�"� f - C .1 � .✓.. E?- kms: -•-•--------------------------•----------- -- -- ------- 17 _ -�-' ---------- ------- -- ---------------------- ------------------------------------- ------------- . ------------ ---------------------------•--------------------------------------------------------------------------- FINAL INSPECTION BY:---- ` 'G=CSI" Date a - SAN JOAQUIN.LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streit 114 Sycamore Street 205 West 9th Street Stockton,California Locil,California Manteca,California Tracy,California £S 9 REVISED B-59 2M 5-62 ATLAS