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FOR OFF US : �S e P� 3 --- _ ------`f �E-? ......._. APPLICATION FOR SANITATION PERMIT Permit No. ..JA5__1?.- ----------- ` --- ---- (Complete in Duplicate) ------ --------------- Application is Iii This permit Ex ices l Year From Date Issued Date Issued A I PP ereby 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 Cou ty Ordinance No.__� 54 . �j � JOB ADDRESS AND LOCATION.. 7-. ---__-- &, Owner's Name_ __ ................................�1 Phone----------------•-•-----• Address. Contractor's Nam ......... ----- --- Phone,........................... Installation will serve: Residence [�Apartment House Commercial l ji: ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms .3_-. Number of baths / /3 ao a Lot sae .. -•--••--------•----- -----•----•- Water Supply: .IPublic system [Community system ❑ Private ❑ Depth ro Water Table 0.. ft. Character of soih fo a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam [�Clay [-IAdobe❑ Hardpan ❑ Previous Application Made: (If yes,date-------_------------) No [5-'- New Construction: Yes �o ❑ FHA/VA: Yes.B—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well __~_--------Distance from foundation__/�_-,._____.Material___ No. of compartments-------2---_-------.._Size------- -lt; X5_'___-Liquid depth___-.---------------Ca eci RG o' Disposal Field: : . Distance from nearest Will.-.' -- ------- from foundation_/�............._ Distance to nearest lot line-_�.../._... . Number of lines `------ Length of each Ii�-: :- - Width of trench...__Z_ Type of filter maferial..._/__.Gl ------_--Depth of filter material/8'_'_`--------------Total len gth___.1.r`?_:�_.....____. \ Seepage Pit: Distance to nearest well-----_�________---Distance from foundation----7� � Distance to nearest lot line...v .�__... Number of pits-----Z__-_-------Lining material- lICA--------Size: Diameter_,33-............Depth----_t ---------------------- ,. Cesspool- Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El i Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacitygals> ❑ Privy: Distance from nearest well _________________ -------------Distance from nearest buildin - f'9 Distance to nearest lot line - Remodeling and/or repairing (describe):---------------------------------- .------------------•-- --------------•-••----•-•----••------- ----- ------------------------------------------------- -----------------------•-------•------------•------------------•------••-•-------------•-------•------...---•------------•--•---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statelllaws, and rules and regulations of t e San Joaquin Local Health Districf. (Signed)--------------"�� --------------- --•---•-------•-------- ----- --------- - ----------------------------- --------------------•------------- -----(Owner end/or Contractor) Sy:•-----------i�--------------------•-•---....-- --- Title _ ...... ____ __ (Plot plan, showiri'g size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side). :III FOR DEPARTMENT USE ONLY DATE------- ..— �-� .. .� APPLICATION ACCEPTED BY____-- 4c. t REVIEWED BY.-.."A ------------ DATE----------------- TBUILDINPERMIT ISSUED ------------------------------ DATE-------------------•- AFferations and/or reeo finer►dations: -. .------- f ._...c:1�a _�, ------------------------------•• ••--- ---- -- ------------------ ----------------� ----..._ --...-------•---•------------- -------------- •----------------------------- ------ -------------• ----- FINAL INSPECTION BY:.-.q._ -------- --. -- ---_ ------------- -•-- - Date.... .-.-/_...------•/..--.-.._ � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 S Stockton,Coiycamer�street Ifoycamer�street 205 West 9Th Street mia Lodi,California Manteca,Colifornla I Tracy,California ' 95 9 REVISED 8-59 2M 5-62 ATLAS