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µ1 V 1 FOR OFFICE USE: f -•-r" ---------------------- w -- � Permit No. ........ ��••.3--`/� APPLICATION' POR SANITATION PERMIT ------------ ---------------------------------- ------- (Complete in Duplicate) Date Issued .__!-_�(-_,-.) -------------------------------- This Permit Expires 1 Year From Date Issued �� Application is hereby made to the San Joaquin Local Health District for a permit to constru and install the work herein described. This application'is made in compliance:with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- - ----- - e G� ----•--- --------------•---- -,-,�-�- -- - - Phone_--_-----------------------••- Owner's Name--------- ------ - -- Address-------•-- . eYk. --------- AM----� .-V....................... Contractor's Name_- ........ .............................. -•---_. Phone.-----------_------_---------- Installation will serve: Residence CR Apartment House El Commercial ❑ Trailer Court E] Motel [3 Other ❑ Number of living units: __I___ Number of bedrooms _ -___ Number of baths __1."_ Lot size ____ ______________. Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table SIP_ ft. Character of soil to a depth of 3 feet:+ Sand ❑ Gravel ❑ Sandy�oam k Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {lf yes,date__-.___.._.___--_--) No P _ 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.) ��.--•----•-•----------- Septic Tank: Distance from nearest well___�_0------Distance from foundation__?0-_-"_____-Materiel______________________.... �] No. of compartments.._______.___.-.- q Ca aci �' _ size.- :E ` Liquid depth p tY l _..V Disposal Field: Distance from nearest well_',. _d_____.--Distance from foundation___ ��______-Distance.to nearest lot I�e_ ......... "-- b--___:---,--'_Length of each line---- ---•--------•-----Width of trench _ .------•-------------- I Number of lines..-___ ____ "" , _De th of filter material----/?.**'*_ --------Total length__/,T---------------------------------- Type of filter materi "_ ' ep Seepage Pit: Distance to nearest well-------Kt92�'-Distance-from._foundation....................Distance to nearest lot line----------------- 1 Number of pits----------------------Lining'.material-_.--------------------Size: Diameter---...-----•-------.-..Depth------------•-•--------------.. T9 t .1 a Cesspool: Distance from nearest well___ .. •-_____s� _Distance from foundation---------------------Lining material--_._______.__.__________-----____-•. ❑ Size: Diameter"-----= ---------------- ------•---Depth-------------- ----•-------•- -- Liquid Capacity.: 9a1s. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------.--------- I❑ -------------- - Distance to nearest lot line-------------• ----------- -�---------;----- --------s------•----------------•------------------ Remodeling and/or repairing (describte):---------------- ----------------------•----------------_------------------------------------------ -----.------- ` t ------------------------------------ ------------------ ------•--------- ---_.. I J ---------------------------------------------------- - --- --- - - -- - -•----- '-- --•-•-------------•---•-•..__..-----------------'----- -'-------`---.--------------"----•^-------------------------•-------- •-------'---•------'-----•---------------- I hereby certify that I have prepared this application- --and that the work will be done in accordance with San Joaquin County ordinances, State laws,and rules a d regulations .of the San Joaquin Local Health District. -17 %, 1- :r----------------------••-•------------(Owner and/or Contracto (Signed) ---(rt ? . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY A - APPLICATION ACCEPTED'BY ..... -----•- ---- ----------------------------- DATE--- -----------•----------"------ - REVIEWEDBY------------------------- ------------- DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- -------• DATE--------------------_--------- ------------------•------- -- Alterations and/or recommendrations:{--- ----------- -- -----•------••-------"•----------•"------•----------•-----------.-.-•----------------------------- •----------- . -------•- FINAL INSPECTION BY:---- ............. Date.- €�.- l�` `(p- ..- 5 SAt4 JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California manteca,California Tracy,California : E5 9 REVISED 8-59 2M 5-62 ATLAS // h/lel , A'