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i' FQR OFFICE USE: 7 (Complete _._-_.__ .______.___.___. APPLICATION FOR SANITATION PERMIT Permit No.c- in Duplicate) v ` ------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 9. JOB ADDRESS AND LOCATI N-;�..2 ---------aA-4–-----W Owner's Name-- ---- --- ---------------- Phone Address------------�-_47---•- = -----------------------------------------------------------•--...-----•-----•-----....---_------- Contractor's Name----------- —---------------------------------------•-------------••--------•--•--------------- ---------------....... Phone.............. ---..__------------- Installation will serve: Residence Apartment House [I Commercial El Trailer Court .[] Motel-❑–Other ❑ Number of living units: ----�.__ Number of bedrooms ---2.--.Number of baths ..�____ Lot size -•-•__6_c,�"�<.�......................... Water Supply: Public system Ar-1community system 0 Private E] Depth To Water Tabie .1�.� ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑] Clay ❑ .Adobe W--"Hardpan ❑ Previous Application Made: (If yes,date-------------------_) No New Construction: Yes =.No ❑ FHA/VA: Yes ❑ No ` TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic k: Distance from nearest well__Distance from founclatiorif ____-----------Materialf _-------------------- ..... :._....._.. No. of comp_artments---- -----------------SizJ_X§VV _J----.._,_..Liquid depth__------------------- pati Disposal Field: Distance from nearest well.__ ____Distance from foundation--LLt--_________.Distance to nearest lot line.&r�...... Number of lines_'___:...._.._ ____._ -----Length of each line_______ �_________________Width of tType of filter materia lfi ____Depth of filter material__7$'_*___'______Total length________`_i Seepage it: Distance to nearest well. --____Distance f foundation..... A.........Distanc to nearest lot iine.-15.......... Number of pits-!__. _______°Lin ing material_ .O('__Size: Diameter------3.3----------Dept h------------A5_------_.______ Cesspool: Distance from neaeesf�well----_------------Distance from foundation-------------------.Lining material------------------------------------- .11 ❑ Size: Diameter--------•---\--------------------Depth----------------------------------------------------Liquid Capacify------•----•-•-•----_-----gals. Privy: Distance from nearest well----------------------------------------- _______Distance from nearest building_____.__________________•_-___.__.._____-- ❑ Distance to nearest lot line----------------------------•--------;----------------------®---- -----------------------------•------------------------------------ Remodeling and/or repairing (describe):_-4n,01 __._. .__ "!.____-_-_--. ------------•-------- ---------•--•--••---------•---------------------------------------------------•-------------------••--•-------------------•------------------------------- • --------••-------•-------------------•---._..-_..--------•---------------------••--------•-•-••-•----•----.-..---------••---------------•---------------- -------•-•------------------------ -------------•----------- ---------------------------------------------------------------•---------------.----..----------- -----•-•-------...---------•------------------------- I`hereby certify that I have pre d this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulatio of a San Joaquin Local Health District. (Signed)---------------------------------------------- ----------------------------------- ------------------(Owner and/or Contractor) B • (Title)_ . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR p PARTMENT USE ONLY APPLICATION ACCEPTED BY_ -------- -------- -------------------------------------------•--------------- DATE_.__...- � � � � --------------- REVIEWEDBY----------------------------------------------- ----------------------------------------•--•..............................:. DATE---------_----------•----*--------------------------------- BUILDING PERMIT ISSUED..............!.._-_------ ...._.-------•......... DATE_.__.....--------- .-----------_ Alterations and/or rete endations:_.___-- --_-__-- -- - i , .--.._.� - :: � ---- f -- . - �---_ --- -- = _.. r� - ; t . I _ _Z ---- Date----- . L ---• ------. ---------------- ---•----FINAL INSPECTION BY:._ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak Street 124 Sycamore Street 205 West 91h Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS _ i