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FOROFFICE USE:- - a r------------ ------- APPLICATION FOR SANITATION PERMIT Permit No. _..13-15- 6) ------ (Complete in Duplicate) J --------------- --------- --- This permit Ex fres 1 Year From Date Issued Date Issued ..../110— Application is hereby made to the San Joaquin Local Health District for a permit to construct andj' all the work herein described. This application is made in cam . L liance with County rdin ce No. 549 /D 306 S• ��} T 'P A°� /d i JOB ADDRESS AND LOCAT N �X 1 - ..f ' .... `.._ •-------- Owner's Name------------------ Phone---- Address - ----•-•- I-------- X.. - `T•- '"------ - -------------_---eo /-)- Contractor's Name............................... - Phone Installation will serve: Residence [a Apartment House 9trnmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: Number of bedrooms ---3. Number of baths ___'vLot size __._ .._ Water Supply: Public system ❑ Community system ❑ Private 0 Depth To Water Table 7- ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay ` t ❑ Y ®' Y ❑ y ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date._/y G��33�I No ❑ New Construction: Yes W No ❑ FHA/VA: Yes Ll No� TYPE OF INSTALLATION AND SPECIFICA IONS:,,--j— (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------r c?._Distance from foundation----77?-4__--_.Material_____ --------------- �.. No. of compartments-----_---- -------Size------- �X �'....Liquid depth------------DKK Capacity--•------G a Disposal Field: Distance from nearest well._/,:�P_o-_Distance from foundation____-K.o--------Distance to nearest lot line__'.'_..... r Number of lines______________________l�zC________Length of each line___ _,_3 3_U,-_ dth of trench.______-...__`ice________. ._ Type of filter material L----.__Depth of filter material1.�!`._.__Total length-------------- -_ ------------ Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line----_______._.... El Number of pits-------------------_Lining material-----------------------Size: Diameter-----------------------.Depth----:----_-------_------- .._ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------..-._____._ El Size: Diameter--------------------------------------Depth----•-------------- Li uid Capacity ' Privy: Distance from nearest well q - ----------'---------••-••-gals. ______________________ _Distance from nearest building ❑ Distance to nearest lot line - ---------------------------------------------•----------------- /Remeling and/or repairing (describe):_____. _ �_,c ._�_��r� -x•,•_tet___� _ - -.-=----•---------3---,6 •-� •--- .- ..- ` -�� ------•------------- -----------•.---•--------•--------- ---------•---------..----- •- - -------------------------------- ••-- ------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ; ordinances, Stat aws, and rules and reg tion f the San Joaquin Local 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 D ARTMENT USE ONLY APPLICATION ACCEPTED BY L- ...................................... DATE---------- REVIEWEDBY ------------------------------------------------------•--------------- - --------------. DATE BUILDING PERMIT ISSUED_.. ---------------- � DATE ---------- ---------- ------------ ANF at;ons and/or recommendations:____ _ .__.- �...••. --__ _- . :." " Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS �� ' ,