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FOR OFFICE-USE: ,. --- ------- --------------------- �' � �. --------------- __.__.__-- APPLICATION FOR SANITATION PERMIT Permit No. ...1l ---------------------•------ ------------------------ -- (Complete in Duplicate) ------- --------------------- This Permit Expires 1 Year From Date Issued Date Issued 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 mid in compliant th County Ord' nce No. 549. q3,f� JOB ADDRESS AT ON -'- T r ,, J a-�— Owner's Name ___ _________ . Phone7`,e ._ � -------------•--------- Address__. G . Contractor's Nam _ _ --------------------------------------------- - '- --• - - ------- _ _.. Installation will serve: Residence pa27- , use [I Commercial ❑ ai er ourt ❑ Motel F1 Other E]Number of living units: /__. mber of bedrooms _- Number of b theL t size r / _.._.X10.................-• . Water Supply: Public system Community system ❑ Private ❑ Dep er Table ___ ft. V Character of soil to a depth of 3 feat: Sand ❑ Grave! ❑ Sand -Loam Clay Loam ❑ Clay ❑ Adobe[] Hardpan ❑ Previous Application Made: (If yes,date--------------------1 No New Construction:-Yes to ❑ FHA/VA: Yes ��to ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS:. ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.)` Septic T Distance from nearest welAD -Distance frrom foundation- Imo} -`-�•-----..__.Material----••------••---- -- ----- ---- -- --No. of compartments__ -------------------Size y� 4s__.---Liquid ------_Ca aci p tY•�6,1C1_ �- Disposal Field: Distance from Weare t well'I� �--Distance rom oundation_/.Q---------Distance to nearest lot line.._____ s Number of lines__ ._Length of each line__ i. '_�__--_---.Width of trench-- -SC��'---- Type of filter material Depth of filter material____ 11� Total length____---__�„�-Q_•-------------- Seepage Pit: Distance to nearest well_-___________________Distance from foundation--- ..-_._____•.Distance to nearest lot line____._...____..__ ❑ . Number of pits--------------•------Lining material..........-------------Size: Diameter------------------------Dept h------••----•-••Cesspool: Distance from nearest well_________________Distance from foundation ------------------- material__--____-______. ------• ❑ Size: Diameter. -__.___..___.__..__.• ------------------------------- ep ----------------------------------------------------Liquid Capacity gals. I Privy: Distance from nearest well-----------------------_____---------------------Distance from nearest building ❑ Distance to nearest lot line------- Remodeling and/or repairing (describe)___________________ ------------------------------ -------- -------------•--------------- •-•----••--------•----••-----•-----••------•------------•------•-------------, -•.................•------•-••-- - ----------------------------------_----------------------------_--------------------------------------------_________________.-________.__-.---------------.._-.____________-___.______---...______.--___.______--_____._ .i J hereby certif thaM - - - - - -------------------•----------...--•----------•----- - ------- y ythis application and that the work will be done in ccordance with San Joaquin County I ordinances, a lations oft San Joaquin Local ealth District. (Signe -- --------- • --BY:--------••------•-- --- ntract -- -- ------ --{Title)----------------- --- - (Plot plan, showing sire of lot, location of system in rel n to weds, buildings tc., ca be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---_7' _R_ DDATE * -2Q 6- .. -- REVIEWED BY... .... -------------------------------------- -----------------•---------------------------•-••--------- DATE BUILDING PERMIT ISSUED-------------------------------------------------------------- Alterations and/or recommendations:--------__._____. t FINAL INSPEC BY ------- - ----- Date--............ Il�r- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Suet 124 Sycamore Street 205 West 9th Street Stockton,California Lod[,California Manteca,California Tracy,California CS 9 REVISED 8-59 2M 5-62 ATLAS