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sU X161�EUSE: �7L = APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued Date Issued ...357.. Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance N�o.�5�,49.� JOB ADDRESS AND L ATION..-•- � "L,� G �- '_ .= Owner's Name___ Address Y... - '� ... - --•//_. Contractor's Name-. s�r�"""""_• Phon -- ------------•------- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other Number of living units: -1----- Number of bedrooms _ Number of baths ❑ ❑ _-. Lot size _. ---.-�-_"•-,�- Water Supply: Public system ❑ Community system ❑ Private �epth To Water Table aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [j Clay Loam [] Clay ❑ obe Hardpan E]Previous Application Made: (If yes,date------ -------------) No [I New Construction: Yes [_1 No FHA/VA- Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) t•c Ta Distance from nearest well_ ---Distance from foundation--------------------Material _________ No. of compartments--------------------------Size--------------------------------Liquid depth--------___-----------Capacity Dis sal Distance from nearest well_!) .-Distance from foundation----- Distance to nearest lot line---- Number of lines_-____I___._ g --- --- ----_"-- --Length of each line-----��__-�•--_"-•--.Width of trench-._csZ.��'/"""-•---""-••- �d Type of filter material""Depth of #filter materiai.__�, fir_-----Total length----l�0 ,- _ .. ---•------..__. Seepage Pit: Distance to nearest welL100----------Distance from foundation___ ___",-Distance to nearest lot line.____ -� yb�( Number of pits-----I_________ _____Linin material_ - g -- ----Size: Diameter-- l��.rDepth__�,S!---••----- •- Cesspool: Distance from nearest we1L_____-----------Distance froDoundation------------------- Lining material_---___-___.___.___-___--___.._ ❑ Size: Diameter---------------------- --------------.Depth--------------------------- -- -- -------Liquid Capacity gals. Privy: Distance from nearest well_________________________________________ _______Distance from nearest building Distance to nearest lot line Remodeling and/or repairing (describe): _ ----.----• - - -------------------------------------------------------- --------- ------------------ ----------- -------------- j-_----------- -------------------------------------------- -------------•------•---------------•----- ----...----------•---------- --- --------- •----- ---------- ----------- I hereby certify that I have prepared this application and that the work wi be done in accordance with San Joaquin County ordinances, a , and rul s and regulations of the San oaquin Local Health District. (Signed).___ . By:_------------------------------------------------- {�� Contract ----{Title)-------- or' (Plot plan, showing size of lot, location of system in relati to�Welils, uildin e+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ______ -__ " �— --�� _ REVIEWED BY- " -- ----------------•--------------•--------------------- DATE------ •-•..__...------ 61; BUILDING PERMIT ISSUED_______________________ __ Alterations and/or recommendations. �t ``I`.._c^ "'` ------------ •- - ----------------------- ------------- -- ----------------------------- ------------ - ----_------------ - -----•-------------- FINAL INSPECTION BY------------------- - ------ ------ Date--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sweet 124 Sycamore Street Stockton,California 205 West 9th Street Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLAS '