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FOR OFFICE USE: ------------ - --------------e!�l2- -Z?---,----- = a. --------------------........�/��_-.---_.__.- APPLICATION FOR SANITATION PERMIT Permit No. . ..5. . .. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .._....r. .... -2,- 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. 54 - JOB ADDRESS A LOCATION---- Owner's Name------ -w- ee_ _... -•----• -------------------------------------------------------------------------------•--- Pho �/_� . Address --------- Contractor's Name. --_._ f -•--------- -- --•---- Phon �?`.� 1 Installation will serve: Residence partment ouse 0--co—mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:__ Number of bedrooms .�4__- Number of baths __ Lot size -----7d---`-x-----/S ---__--_____. Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table _'a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B`-Hardpan ❑ Previous Application Made: [if yes,date------------__3„_;)*.No ❑_ON New Construction: Yes ❑ N HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION/AND SPECIFICATIONS: (No septic Tank for cesspool permitted if public sewer is available within ZOO,fee.f.) Ilk �, Septic Ta Distance from nearest well_/V�vT._Distance from foundation_______________Material._____.______ __-_.._..�_.....____._..___..__. No. of compartments___ ______._. -____.�Size `�K.�_y __:...Liquid de fh_6.fr'!____________Capacity ....6od 1 F Disposal Field: Distance from nearest wellWP-t------Distance from foundation__-____.___.Distance to nearest lot line... 5.'::._._.3 ©— Number'f lines______..._. __-.5- Seepage Length of each line......��__�1__`JLl1'.Width of trench-___c�_$'.!�-__"___-_...___ yp ¢ Depth of filter material.._./ Total length______�Q...........................T eof filter material « /Number of its" g •� � ___.Distance fo nearest lot line_ _. ..Pi : Distance to P ear ell_- - __Linin mbteraaE a om foundation-/-O.-ize: Diameter.__ _ _. ' ------Depth-- �. ..... . .. Cesspool: Distance'from nearest well__________ _____Distance from foundation--------------------Lining material...-----------------------__"_--_---- ❑ Size: Diameter---- ----------------------------Depth--------------------------------------------------._Liquid Capacity----------------------------gals. Privy: Distance from nearest well_-____..___f_-_-______________________________Distance from nearest building____..___.______-__-_---. -_-_ ❑ Distance to nearest lot line----------------------------- ” Remodeling and/or repairing (de ribe): - --------- ------•--------•-----------------...... ti •------"------------- ------------------ -... .. .- -----------•--- --- ------ - -- -----_...- ------•----•-------•---------------- -•------------- ----•--------------------------------------------------••------------ ------------ ----- -- - -- `-- . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules Knregul ions of f n quin Local Health District. l +� , (Signed) _ .r. Contractor{ I----------------••-•--------•--•----•--•--- -------------- rifle_ (Plot plan, showing size of lot, location of system in relaf' to wells, buil - gs, etc., can be placed on reverse side). • FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--/� . ._ yDATE � Z' - Z REVIEWEDBY--------------------------------------------------------------- - t -`- - JJ..._ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED _�� -. _ ^ __-_- �` ---•------ ` - a•�c�-i sem' ��r�c -P'=�- DATE.-----••-----••------------ -----------------------•- -•- AFteratio and/or reco menctations:_-_-__ '_r___r c---------------------�- f�=' ."`-- _.'7.: - -------- ........ "' �" r------ --------------- -------- --------------:•�---------------- = 1 -. ----------------- ------------ - —� �-- _ -------------------------- C 1 ff/✓.. .- - FINAL INSPECTION BY: -- - --------------- . --�--------f---�----r-ar-"- --r-te--'--- ---------------- --------•-•-- SAN _ JOAQUIN LOCAL!HEALTH DISTRICT 130 South American Street 300 Wert oak Street . - i 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9 9 REVISED 5-59 2M 9-62 ATLAS