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F: FOR OFFICE USE: i -------- ------------ ` APPLICATION FOR SANITATION PERMIT Permit No. �..�. --------------------------------------------------------- (Complete in Duplicate) ` ----------"--- ----------- --------- -------------- This Permit Ex fres T Year From Date Issued Hate Issued ... Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. �j This application is made in compliance with County Ordinance No. 549. .22 P--17p —t� JOB ADDRESS AND LOCATION.......... -3_g25S'_. & .L ^r -•-----._ -_-. v .....-------••••............... Owner's Name ------- - --..... . S--... . S �3 �0 �"''�_�$'�_ .. - - - - --------- ----�--------•--••---•-•--- -------- Phone--- ys 00 Address.-----•-•-•-•----•--••---. -------•------------• ------------••- `? y -----------------------------------•-------------- Contractor's Name ----••-- --•............... . ... _ ------------- ------------•------------ -----..----........._- Phone. Installation will serve: Residence 0— Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living ur6ts:—l__ Number of bedrooms _ _- _._ Number of baths _`� Lot size _--_/- - Wafer Supply: Public system ❑ Community system ❑ PrivateA Depth To Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote_.-_ -------} No ❑ New Construction: YesX No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_S0_----.Distance from foundation---- -/----.Materi --------------------------•----,-_ O No, of compartments-, -- ="�� p Size.----- Liquid depth----- X 1 Z a( � -Ca pacify Di s Field: Distance from nearest welL_.�-- ---Distance from foun atio ___-....-- ®---. istance to nearest lot -------- Type _ --_•- Number of lines___-.--..? _ -______,Length of each line- - -�� v 4 Q Width of trench.__.---- - - 'if T e of filter material__.___- Depth of filter material___-.--_-1-r`�-.--Total length................... _f--/o- Yp Seepage Pit: Distance to nearest well_--------------------Distance from foundation----------........-.Distance to nearest lot line......--3. 79 y - ❑ Number of Pits----------------------Lining material.--------------------- Size: Diameter----_----------------Depth-------------------------------- Cesspool: Distance from nearest well------- ------Distance from foundation---:-----------------Lining material----------------------.--__-..__-. Privy: Diameter----•--- •--------------------------Depth-------•---•-------•-------•------------ Capacity----.-Liquid Capac ----------------------------gals. vy: Distance from nearest well ------------------------------------------__.....Distance- from nearest building ❑ 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, State laws, and rules and regulations of the San Joaquin Lftai Health District. (Signed)-----• •------•-------------- ------------'----- - - {Owner and/or Contractor)-" By:......•---•------••-•---••---•-•-••---------------- - - -- Title ------------------ (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 APPLICATION ACCEPTED BY---------- F4:: ---------1. REVIEWED BY------------ --(� DATE:----- '.'_ FDATEBUILDING PERMIT ISSUED ------------ ------•--•---------------------------------------•------------•-- DATE-.-.---------- Alterations and/or reco mendations:- -.-_ ------------••---`------_----"• -- ----- --••--- ------------- --•---L�f f�._ a f----9��_-_�----- 0W... , - - , ��----�'!1... •-. 'IR d --•-• -------•-----� .f9-�.-- 'Rk .L,. 1✓1.5- ---n1 �-1 /4T-----••----.fix-D 4 .. N -t-1 ------ pRim TlI�t --------------••-------FINAL WSPEC _vp Date--------------- Z�- 6 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak STreet ti - 124 Sycamore Street — _ 205 West 9th Street S+ockton,California Lodi,California Manteca,California Tracy,California Y ES 9 REVISED 5-59 2M 5-62 ATLAS - a