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ry/jrrI,— U t: vl t -- "APPLICATION FOR SANITATION PERMIT Permit No. _�e.. '� IMI (Complete in Duplicate) ---------- ------ ------ ---- This Permit Expires 1 Year From Date Issued / - �= Date Issued Application is hereby made tothe 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. S i_4m s,. IJOB ADDRESS AND LOCATON ..................... �.�xas Owner's Name--------1�ER.i_--_ ................. ------ -- -------•-_---------------- -•--•--------- -�•-- ----------------------------------------------------------------------------------- Phone............................... -----------------------•-•--•-------- ----•---•---•--•--•-•------•----------------• - .--- --•--- - -- -----.----- Contractor's Name------------ ?! I +�.l: _lf .__._` ° `'`� ..kN_ .-- --" " ................ Phone../. i!_.Fi._g_rti_A._7..--.•--- Installation will serve: ResideriM a [3 Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other.❑ Number of living units: .1-/____ Number of bedrooms .__yNumber of baths ._.lLot size .._.___�Q.-� X-... ..................... _ Water Supply. Public system 1E1 Community system ❑ Private ❑ Depth To Water Table _9p_ ft. f.�4_. Character of soil to a depth of feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ I Previous Application Made: (IfByes,date__------------------) No,® New Construction: Yes E] No jo FHA/VA: Yes ❑ No R] 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_____________________".___ _ I -------- ' El No. of compartments Size -------------------- ° Liquid depth Capacity Disposal Field: Distance from nearest well -Distance from foundation-_---L_P..�.___.___Dis#ante to nearest lot line.___3 __...._. I. ® p�D Number of"`Ines----.------f---------------------Length of each line----------_3'�-'--.._----Width of french------_-2._V,y---"-- ------ Type of filter material._/?d_O C-----___Depth of filter material------/_$"""--"-Total length.----_-------1f'---------------- Seepage Pit: Distance to.�earest well__/l�4yG__--Distance from foundation___...10.'____.Distance to nearest lot line...�3_..._____.. I�• It�p Number of pits------ --------------Lining material.--- 0.4' ---.Size: Diameter--------- 3."--•.Depth-------------- _}" Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material................._.____-. ❑ Size: Diameter------------•-------------------------Depth-------------- -•----•----------------------------- ------------------ Liquid Capacity l� ---- -- q � •-------------•------------gats. t Privy: Distance from nearest well------------ -------------Distance from nearest building ------ Cl Distance to" earest lot line---------------_________________"- 11 Remodeling and/or repairing (describe):--------- f ---- ,��--- -•--------------------------•------------- ------------ - ------•------------ ------------------------------- --------------------- l ; - ••ere •-------------•----------"----------"-"--------•--- - ----------------------------------- I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and ruler and regulations of the San Joaquin Local Health District. (Signed)-----..--- '- E '_��a -- ._ � ------�-±..�-------------------------------•------ By:..................... _ (rifle)-------- �J n -- and/or Contra------- �. ctor (Plot plan, showing size of lot, lai�ation of ystem to relation to wells, buildings, etc., can be placed on reverse side). ��. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_�,I - - --------- ----- -- --------------- ---------------- --- DATE -�REVIEWED BYC "_. -- -------- ------- --------- ---=---------- -- ---------------•-------------- ------ DATE- - - -BUILDING PERMIT ISSUED---------- •----- ------------ ` - --_-.-"-"-._--. ----•----------------------"- -"-----:--------�—y--�-----t---------------------•--z-------�- DATE ................-•---� ---Alterations and or recommendations: �� i' _ � -- -`W e,(..-_. _ c--•------------ --•--------------••------------------------------------------------------------------ ---------- --- ---------- --•--------------------- -------------------- -_-.-� -- ------------------------ •----••------------------------------------------ FINAL INSPECTION BY:. Date -----------"---- - SAN J QUIN LO L HEALTH DISTRICT 130 South American Street 300 W t Oak Sir-of 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS -