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� FOR OFFICE USE: '� -�. -7 �.?-:_ z? APPLICATION FOR SANITATION PERMIT Permit No. . ......._....... --- ------------------------------------- --------------- (Complete in Duplicate) ---_-------------------------_---- ______________________ This Permit Expires 1 Year From Date Issued Date Issued 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. S49. JOB ADDRESS ANDi .. ... f �s`�' �s 7� _r'`' � Owner's Name WC)rAT == ._..... Phone Address.... ------•--------------- •-------------- � -------------------......._...---------------------------------..------------------------------------......................... Contractor's Name.-•----••------•r -------------------• Phone. .... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms J__ Number of baths Z-_- Lot size ............................. Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table M. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--*Hardpan ❑ Previous Application Made: (if yes,date---------------_----I No 'New Construction: Yes Ee,"�o ❑ FHA/VA: Yes 21""No ❑ 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____—-------Distance from foundation___._ --------Material____ _c=_. �-% `! ....... i No. of compartments......r�-__....____._---.Size_ �r, _4/P__'.___Liquid depth-____��_-P/-----------Capacity... ....._ Disposal ,Field: Distance from nearest well... -------Distance from foundation---&--------Distance to nearest lot line.s;_�_.7........ [� Number of lines______+.._ Length of each line_•Xt9_°_._ Width of trench__�.r.�___________________ O Type of filter material V19 -Depth of filter material../ ---------------Total length- ref _. Seepage Pit: Distance to nearest well------`--------Distance frrpm foundation__,��_,-----.Dista i e to nearest lot line_`.~l-_--_-- Number of pits-----s2_____________Lin ing material__ � .._Size., Diameter_,._._..._...Depth_a?v--.6r�1 ---------------- 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------------------------------------------ ElDistance to nearest lot line-------------------------------------------------------------------------------- - Remodeling and/or repairing (describe):-------------------/11e4 - ---- •--------••-------------------••----------•-•--------------------------•---------------•-------------------------------•------•-----------------•---•--•----...._.----------------------- 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 regulations of the San Joaquin Local Health District. = Contractor) (Signed)--------•-••••••........--•••--•----•------- - ------ ----- B • • - ---------------(Title) /1 ' Y•---------------------------•............._._.....-----------------------••-- (Plot plan, showing size of lot, location of sys+em in r tion to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY �f APPLICATION ACCEPTED BY" _l_v-- ----' DATE__,_1 Z --. -` ----------------------- REVIEWED BY ------- - - --------------------------------- ......... --- DATE-------------------------------------...................... BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-----------------------------------------------------------------------------------------------------------•-...•----•----....._...........---•--......._.---- -------------------•-------------._-_-.----------------------------•--•-------------- ----•-- -----•---------------•-•---•-------------------•_.._..-•--------------------••------••-•--------_-._-----------•_-•-_.-_-••--_- ��, FINAL ------------------------------------ BY:..-• -------- ------------------------------------ -- Date----------..-_:...-- - ------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 12 4 Sycamore Street 205 West 9th Street Stockton,California Lodi,California _ Manteca,California Tracy,California Eg 9 nEVISEO 8.59 2M 5-61 ATLAS J J