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FOR OFFICE USE: ,. If `'-----"..�---------- Permit No. l - ., -------------------- APPLICATION FOR SANITATION PERMIT ----- (Complete in Duplicate) Date issued ....- .. .; / This Permit Expires 1 Year From Date Issue 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___._ ---------•-vv-o•---------- V....... - --------------------- -•-•--•---••--••----••---•----- Owner's Name------- --�•------- -�----------- L kr•��F OttV!A----------------------------------------------------------- - Phone----------------------------------- Address--------.... ............................... - - -------------------------- Contractor's Name-------- _LQ-----•---------------------------------------------------------------------------•------------------------------•------ •-- ----------------------------------------------- Installation will serve: Residence ta Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: _.�__.. Number of bedrooms -�.. Number of baths _.�_..__ Lot size __-I-, -------K•-(-Q•� Water Supply: Public system ja Community system ❑ Private ❑ Depth To Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F1Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobetg Hardpan [j Previous Application Made: (If yes,dote-------------------.) No & 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.) I Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-------------------------------------------------- ---- :- -Capacity � �[ 1 No. of compartments ----Size---------------------------I---Liquid depth-------------- -...._.----- --.�__-- Disposal Field: Distance from nearest welL_fLQ1 _-.Distance from foundation----I_Q�__--...Distance to nearest lot linet_i_.�. Number of lines-----__)--------------------- ----Length of each line__.____-_Q --------Width of trench------- 4:------------------ 4 Type of filter material __r� _Depth of i,,.- -------- length ie4e'p',ge Pit: Distance to nearest well-----.-____._______-.Distance from foundation............. .....Distance to nearest lot line____.___.------- W I Size: Diameter----------------------Depth--------•----•----•----------••-- ❑ Number.of pits- Lining material a ._'. Cesspool: Distance from nearest well_________________Distance from foundation_--____--___-'i___-.Lining material_._-__-.___.______._-••- ala. i ❑ - Liquid Capacity----------------------------9 Size: Diameter------------•-------=--------------=-Depth_..-•-----------•------a' r 1. Priv Distance from nearest well___-_-.___-___- "_______________________ __ __Distance from nearest building.____._____.___._____.___..__-._-.____._. Privy: ❑ Distance to nearest lot-line - -- --------------- i - ------------------ Remodeling and/or repairing (describe):__-:a 6 - ------- t `fes -------•---------•------------------ = -------- ----------- --------------- 3 -------•-•-------••------------------------------------------- ---------- y -------------------------------•--- ----------------•-----•-----------------------------�__`.•----- F I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances tate laws, and rules and regulations of thi elSan Joaquin Local Health District. (Owner and/or Contractor) ;r i (Signed) i ' t-.- __'" - — -------------------(Title)-------------------------------------- By=-------•-----------•--•------------------------------ ---------------------=--------•--------- (Plot plan, showing size of lot, location of system in rela„t�ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT-USE ONLY - ------ ---------_------------- DATE-----�-'--=-�"-�--'--�-�'----------••-------------- APPLICATION ACCEPTED-BY_____C_->.--�5------------------- - �' DATE-------------- -•-------•----------------•------ ::... -- - REVIEWEDBY--------------------------------------------- DATE--------------------------------------- --------------------- BUILDING PERMIT ISSUED-------------------------------------- _-------------------- - ---•---------------------•- Alterations and/or recommen a tons______________________ •----- - ------------------------------------ --•----------•---------------------- . c - - '-`---i V-=--�- ---- - ---------- --- -------------- - FINAL INSPECTION BY:----- --�------- �-------- ----------------------------- --- -------------- ------- Date._._ ---- ---- ---- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT f Strer m 205 West 91h Street 300 West Oak 130 South American Street ist 124 Sycaore Street Tracy,California Stockton,tolifornla Lodi,California F Manteca,California ES 9 REVISED 8-59 2M 5-62 ATLAS '""•