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FOR OFFICE USE: _ - --- --- •-- - - ----------- `J 17 - -_- -_--- --- -- - APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued --� .�/ ------------------- - ------------------ �--;1-/a_/ � 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 descr' This application is made in compliance with County Ordinance No. 549. 1�1 ----------- Al -.�.t'lLn,�.rJ ......----•----• ..w�---•------ �rr' JOB ADDRESS AND CATIO ______________________________�� "` Owner's Nam --------------------- Phone... a --------•--------- -----.�.....- TI7 r - ----•---•------•-._..... Address------ - - ------ - ------•- ----- --------- / d Contractor's Name- -- Phone. ..... Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: __�._ Number of bedrooms ,;--- Number of baths -�_____ Lot size ______________________ --------•---.....---••-- Water Supply: Public system ❑ Community system ❑ Private 2r-16epth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [3 Clay Loam © Clay dobe❑ Hardpan C]', ' Previous Application Made: {1f yes,date--------------------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No C1 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---------------- Distance from foundation.------------------Material_________--____._-______-..._.--..-___:.._..___-- ❑ •----- --Li uid de th---------------- ---------Capacity— No. of compartments-- - ----- ------ ----Size..-------------•-- q R --• -----=------..__ i Dispos Field: , Distance from nearest well-_.__mow----Distance from foundation__----- ___',.-.Distance to nearest lot lii�ne____._r__....... J __Length of each line____.-.�20------------Width of french___ _____.-_____________ _ '� Number of lines------••----/------------- - 9a + i Type'of filter materlal._.�r_1cf/�--.--Depth of filter material_._-._�.�____.------Total length..____f__.�---------------------------- - Seepage Pit: Dista"rice to nearest w.ell_, -_..___.______-_--Distance from foundation....................Distance to nearest lot line____.-r___.____. ❑ Number of pits--------- `= Lining material-------- --------------Size: Diameter----------------- -----.Depth---------- --- Cesspool: Distance from nearest well:=__.-------------Distance from foundation--------------------Lining material------------------------------------ ❑ Size: Diameter-------------------------- =--------Depth----•--------------------------------------------._Liquid Capacity gals. Privy: Distance from nearest well__.a________ ___ Distance from nearest building_______..-_____-------..._.--:---------fA ❑ Distance to�nearest lot line---- ----f-�`---�--------- ------------------------------------------------------------- ------------- -•------------ , --- Rem on r reaisndescri,U,e :__ ____-_ ___,_,_______ t--------------------------------------------------------------- 1. � .-="r � �. -; - --------------------------------------------- ------ -------------------------------------•-------------------------•------ I hereby certify that I have prepared-,thissappiication and`fhat the work will be done in accordance with San Joaquin Count ordinances, State laws, a rules and regulatlo of the San Joaquin Local Health District. 1 (Signed) --- ----'- ------ ----- ----------------------- -" and/or Contractor) BY: r �'i (Title) _—_--------------•---------:------.- ------` { -- - - - - - - - --------------•--------------------------_ -,"� (Plot plan, showing size of-It, location of stem i elation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY I w APPLICATION ACCEPTED BY- ---------- -------- DATE J°� -/-d--------------------------- - - REVIEWED BY------------------------------------------------------------------------------ DATE----------------------------------------- ---- i BUILDINGPERMIT ISSUED---------------------------------------------- -------- DATE-------------------------- ------------------- -------------- AFFeretions and/or recommendations:--------- ------- ---- ------------- -------------------------------------------------------------------------------- ---------- 1 l�- - FINAL INSPECTION BY-- -- - ----------- --------------- -- ------ SAN ----SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wed Tr Oak Street 124 Sycamore Street 2 West 4th rat Stockton,California Lodi,California Manteca,California \, Tracy,Californinia v�y E9 9 REVISED B-59 2M 5-62 ATLAS AlA