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FOR OFFICE USE: ) / --- ---- ......-- - ----- APPLICATION FOR SANITATION PERMIT Permit No. / --- --------------- ------------------ (Complete in Duplicate) Date Issued ..........._.............. ._................ f This Permit Expires 1 Year From Date Issued (0f-7 - b { O^© 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. r2Z'3`f2AJ :-RF W1 49 - 9 --------------° - ' - -........... JOB ADDRESS AND AT . ... ........... v�-- --. "-- Owner's Name.......... ........ . -- ------ ......._-....------------------------------ Phone-. -•----......................-- Address------------------------ -------�-�-42 t4?w...s ......--.......e� .............................. ...-................___.............................. -- ((JJ ..-=-zl------------------------------------------- Contractor's 'Neme_.._.... ...__-F -- _. Phone..................-- --.--- - .... --- ...... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I jber �"�� U Number of living units: J.... Number of bedrooms ...1^c Number of baths .1.... Lot size .._'. ------------- - --- ----- Water Supply: Public system ❑ Community system ❑ Private RI Depth To Water Table y�7 ft. I f� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loom 10 Clay Loam ❑ Clay❑ Adobe❑ Hardpan❑ • Previous Application Made: (If yes,dote....................) No New Construction: Yes J No ❑ FHA/VA: Yes ❑ No El ^� 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...0O........Distancp from fo/undation...JA....._....Mast/erial...�a(CYiE' ..................... No. of compartments........ ..._.Z...............Size..11VA '...Y=r-tT�-------Liquid depth.......:1................Capacity.,f.�- ......� e Disposal Field: Distance from nearest well--nSO- ....Distance from foundation.....f.A........Distance to nearest lot line...ss............ Number of lines`...... ...............}.�....JLength of each line-.----- d._. ----------_ Width of french..... ._�............_.... Type of filter m6terial. !.1fd�1-Dep+h of filter material_..._1.9------ ...Total length.._./ -----_-_---- I :_--_. ................ ' I 11 Seepage Pit: Distance to nearest'well......................Distance from foundation.... to nearest lot line................. ----- ` ❑ Number of pits.I....................Lining material._........._...........Size: Diameter.......................Depth._..------ \CCC` Cesspool: Distance from n 1 earest well.------_.......Distance from foundation.............-------Lining material..................................... ❑ Size: Diameter-I- ......... - .........Depth------------ .. ..........---------------------..Liquid Capacity----------------------------gals. Privy: Distance from nearest well.......----------------- ---- ............Distance from nearest building---------___------ .-_-------..... Distance to nearest lot line.............: •------------------'--.._................_.....------------------------------.-. Remodeling and/or repairing (describe):.--------------- ----........................... '.I...............•---- -----------..__............................. - I --..... -._........................................................ -� ......................... . .. .-�---- ....._..................... --f_.....------------------------------- -------------------------------------------------.._.. ----------._.------- - ................ I herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate law _a d rule end regulations of the S�n Joaquin Local Health District. a (Signed)..... .... (Owner end/or Contractor ..... - . ... .. . - ................. ( TM le -- - - .... • - ---(Tit ..........) (Plat 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--- /i/^�`3`----------- ................ REVIEWEDBY----------------- --------------- --------------------------------- ......--------.. DATE..................__-----------.---------------------- BUILDING PERMIT ISSUED.......................... .....-----------......-_ ........---------_-----.------ ............. DATE----------------------------- -----------------..._ - Alterations end/or recommendations------------------- --------- ---------------------------------- .......----................ -----........................-------------.....- .....................- ... -- .......... ..._._........ -- ..._..._........_.. . --------......--__................. . ................. -------------------...----.........................................---------- 1 _....................................... -- ....................--- .... .............- -- ...._....... . .............................................. i ...........................---------------_....................... FINAL INSPECTION BY:.. '// ------.--------_ Date---s 7--n.1z-......r.._3.............................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stroh 124 Sycamore Stmt 205 West 9th Street Stockton,California Lod 1,California Manteca,California Tracy,California ES 9 REVISES S-59 2M 5-62 ATLAS 3 ? --\ z .