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rUKUrrlt-t UJt: 1 � --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------ ------ (Complete in Duplicatel Date issued -21161(-- _ --- -------------------------------------- -------------- 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. !t 3sr jE . ��-��c•ar—�. �J J JOB ADDRESS AND LOCATI N__aL 6u :-y�cru C ,�+ �.�,��(1 ac a� C-�� ,� 4: 0-y� 6 Owner's Name-------A-&--- -- ••--• •----••---•---------•--------•-------------•-------- -------- ----------------------- ------ Phone------------------------------------ Address.......... 2io.-j 3. f � = -� - -------- Contractor's Name---- /..2!!1 '. c ---- ` !r�.. ---------------�'-------••-----•-••------ ------ Phone................................... Installation will serve: Residence [r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I---- Number of bedrooms .A' Number f baths ---1--- Lot size .��..`��_____________•,-.--- -„ Water Supply: Public system C] Community system ❑ Private [Depth To Water Tablet .. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel © Sandy Loam ❑ Clay Loam (,Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date----- --------------) No ? New Construction: YesAV 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-----------------Distance from foundation--------------------Material-------._-.-_-_-......-----------_------.-....... ❑ No. of compartments--------- -- ---------•--Size------------------------ -------Liquid depth.---------- .-Capacity....------------f--- I If Dispos ' Field: Distance from nearest welL-50_ --.Distance from foundation-...I .........Distance to nearest lot line....,�."........19 Number of lines-------------I------------------Length of each line-----..-&9--------------Width oftrench----_.-�'r_-_...•--__.••----------- t Type of filter mate ria l._..A&tA------Depth of filter material..._. Total length...__..6t1............................ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line....._.-_..=...._ m '. El 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------------------.--------------------.- - ----.Distance from nearest building--------------------------------------- Distance ---_ .-------------_-_.....- Distanceto nearest lot line -------------------------------------------•---------••---•------------•--------------------------------------- Remodelingand/or repairing (describe)---------- - ------------------ - ------•----------.....---------------------------•-•----•-•-•----•------••-------------------------------•--•-•--- ----------•--•---••----------•-------------------------- -------• - f,� ,�------�--------•-•----------•-----•-----------•-••---------------- --------------------••--------------- •-----•----------- --------------• ---••----------•---------•---------•---------------••------------ -----------------------------------------------•---------------------------•-------------••---------..---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5ta laws, and ru! end regul ns of the S Joaquin Local Health District. (Signed)........ - . -- _ -----------------------------------------------------------(Owner and/or Contraeforl ----- 4 -- t By ---- - --G ----------- -----------------------------------(riifle)-------------------------------------- ------------------------- (Plot plan, showing size of I , location of system in rel ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------ -- ------ ------------------------------------------ DATE-----3-��•-�^--------------------------- REVIEWEDBY----------------------------------- --------- -------------------------------------------- DATE BUILDING PERMIT ISSUED--------------------------------------------------------------—----------------------------.......... DATE------------- Alterations and/or recommendations:--------------------------- FINAL INSPECTION BY - ------ ------ Date �3 �- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED a-59 HM 5-62 ATLAS