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FOR OFFICE USE: "7-L ? s /�------- APPLICATION FOR SANITATION PERMIT Permit No. Z....I- /....._ . ----------•----------------------------------------; i (Complete in Duplicate) Date Issued _J_r_.�....... _ ___________________________________._.._._..___.___.__. This Permit Expires 1 Year From 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 made in compliance with County Ordinance No. 549. JOB ADDRESS AND LCATION_.___ _ `� ---- Owner's Name - ------_ ------------ •----- Phone Address------------------------•-•----- -----• ---- --------- - --- - -- - --- ----------------------------------- PhoneContractor's Name •. - ---------------------------------....-------- ----------------------• _. ..` .. �. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/_-. Number of-bedrooms A_ Number of baths __/_ Lot size ____. ,_-3� �.4-._r7----------------------- Water Supply: Public system [ Commuri:ty system E] Private E] Depth T6 Water Table tt. fe t: Sand. Gravel Sand TLoam Clay Loam Cla !Adobe[Hardpan ❑ Character of sol) to a depth of 3 e .❑ ❑ y ❑ Y ❑ Y ❑ I , f e � Previous Application Made: (if yes,date_I .S-4--.---) ;No E] New Construction: Yes [�No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1` `\ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - ,. p I ani: Distance from nearest well_______________'Distance from foundation....................Material...__-.k----------------------------------------- No. of compartments---- -------------------•=Size------------- -----------------Liquid depth--------------------------Capacity------------•--------•- _Distance from foundation._ Id: Distance from nearest well - .._-.__.Distance to nearest lot line... ...... Number of lines___..__.f.... Length of each line_____ _�-�__-. ___ _ Width of trench...... a ®� I !l 7 Type of filter material.�� _ __Depth of filter,material______,�.�.________Total„length_______________________�40-.......... 9ee e" it: Distance to nearest well----------------------Distance from foundation.........-----------Distance to nearest lot line----------------- Number of pits'--------------_ _Lining material-----------------------Size: Diameter---------------------..Depth--------------------------------- Cesspool Distance from nearest well________________•Distance from foundation-------------------- material-----------------.______________-_- ❑ Size: Diameter 1----------=-------------------------Depth------------------.------------------- --------Liquid Capacity.......---_--------------.gals. Privy: Distance from,nearest well___________________________________________ Distance from nearest building_--.....------_--------------------------- ❑ Distance to nearest lot _ _line----------- -------------------------- -------- ---------•------:-------------------------------._. ----------- ------------- Remodeling and/or repairing (describe):__ . _ pfd_`vF.- ... : � %[�----- K--_-----••- f �' --------------------------*L--------- c •"--•-- --------------------------------_ •-•------------- I _. ------- ------------- ...------- - I . ----------•-----•---------------------V7 - I here I that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , St a la s, and r les end ulations Of the San Joaquin Local Health District. i ----- (Sign( .... ..... .... .... --------- --- --- ._._..----- ner end/or Contractor) �iT.;z ------------- ----- -------- -------------- -----•-••------ p a ] (Plot plan, showing size of lot, location of system in relation to wells, buildin , etc., can be laced on reverse side). I �. j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------- ------------------------------------- = DATE------ — _ ----------- REVIEWEDBY_. ------------------------------------------------------------•----------•--------!�DATE--------•---•-------_------•---•----•------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------------------------ -------------------------------------------------#----------•--------------•--•-•-------------------------- ------------------------------------------------------•-----•-----------------.------.•-------.---•-•---------- 1 _.--.-.---•------------------ .-------------•--------------------------------------------------- _ ---------------------------------- _f/ . FINAL INSPECTION �- - 5PECTION BY:------'"��----- -- ---rte`-' ---- --. Date----------- -- �-- -;- ------- -•----------'-------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Strut 124 Sycamore Sleet 205 West 9Th Street Stockton,California ( Lodi,Caiifornia Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS