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I . -........t-t-.. -.�..� AF?LICATION FOR SANITATION PERMIT Permit No. __./..�. (Complete in Duplicate) �� ------.. . •----- -- This Permit Expires 1 Year From Date Issued Date Issuedj _.Z� 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.... .... �j `:_�` `'��---- -------------•------------ Owner's Name........... �ll :� ..... --------...�� :.�-->>a�-�-��:!?-:'.............. Phone�•--•--••-•----.......... Address..................... ��' l"----------------- -------------------------------------- -----------------------------------------••-• Contractors Name -- ...-----�....----••-•-1 ......... Phone.._...... Installation will serve:. Residence gJ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _Z:::'Number of bedrooms - Number of baths ._ Lot size ......____._ - .�n � Water Supply: Public system ❑ Community system ❑ Private jo Depth To Water Table 2--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑x Clay ❑ Adobe ❑ Hardpan p Previous Application Made: (If yes,date ) Nog 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.) O� Septic Tank: Distance from nearest well--- c'.4..Distance from founds ion._..../.5�?.......Material_.......sF ® /iJ Ij�No. of compartments..._......?—......Size.../1._X_ !-�` Liquid dept _�Capacity..__l_ -�_.�: 4 Disposal Field: istance from nearest well_.._.y."'_'Qistance from foundation._..5`.__Q....__Distance to nearest lot {" 3 `'/Width of trench_____________?f Number of lines______________ Length of each line_.�_�._.'. [./ ........___.__. Type of filter Depth of filter material......--,r. ......Total length----- ------ .............. Seepage Pit: Distance to nearest well .... Di;tante from foundation__._. Distance to nearest lot line_.._lD.� Number of pits.....Z�........Liningmaterial..yG�rr Size: Diameter...J.s_.::........Depth........ . ! ............... Cesspool: Distance from nearest well.................Distance from foundation..,..................Lining material._.... ❑ Size: Diameter.............................. Depth------- ----- ------------••-•----•---------------Liquid Capacity............................gal . Privy: Distance from nearest well..........................:s..._...._.... . .....Distance from nearest building......................................... ❑ Distance to nearest lot line........................•....-----•-•-------- --..---------••-•---••---••-•---------------- ------------------........*...........*-----. Remodelin and or re airin describef-s:�_._._ e+- x�c �.__ ' �j / P 9 ( ) . .-:t..Gp..:..LllZtFkSE4c._�.--1�'----....!!Y•._.� -..__/`::4 -.. ��n_ .--^ �-'•=------ --- - ------•-••----''', - - --••-•---••-- f 5 ............ . ..... =""---------- - �i�=� ....rL-f..l:�:4..�l►•.� I hereberttfy that I have pr red this applicati nand that the work will be done in accordance with Sen Joaquin Cpunty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (SignedB)_y_.:._. _� . ------- - C ----- � , •--------•-----------------..(Owner and/or Contractor) % � ---t., -----(Ttle).. . . .................................... ......... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc; can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----- --- -- r4:�``�--------..... ----------- ----- ---- --- --------- DATE............. .1..- �. L.............. REVIEWED BY ...................................... DATE--............................................................ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE................. -------------•--- -_------------_------ AlteraIons a d/or recommens�d+sations:.... _------------------------- ------------------------------------------- ----------------------- -• / ............................................................ /4;7 ........... .......i!i.f. t:_i^1.:...... ........ TJ ✓ .y / mac. !//`/J •' �. ....._. w_-✓.:.. ie►=cw ...__.. .^ ................. ._.v :�...!._.._.�I(�C.•..�s. .._...�.r• :dP..l--w�--•...__..._ ✓. .. . ........... ........ — - -- FINAL INSPECTION BY:................................................................ Date----.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srroet 124 Sycamore Stmt 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS