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FOR FFICE US -lie // __. I APPLICATION FOR SANITATION PERMIT Permit No. .. �r�,l.� --------------------- ------------ --------------- (Complete in Duplicate) D }� -.--- This Permit Expires 1 Year From DAe Issued ate 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 complian 6e with County Ordinance No. 549. 71 ��Z ----JOB ADDRESS A LOCATION__ . - - - - .. --___ --- Owner's Name-- Address------_-------------- ame-Address------••--------------- ---- Contractor's Name................. ;.-1 Phon .. .... g f �f Installation will serve: Residence ❑I Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [f� 647 Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size a+s-�r f J •- �a ---------------- ---- Water Supply: Public system Community system ❑ Private E] Depth'To Water Table4-40. ft. Character of soil to a depth of 3 fear: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe hardpan ❑ Previous Application Made: (if yes,date__'_________________] No ❑ New Construction: Yes ❑ No *"1FHA/VA: Yes ❑ No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.)f Septic nk: Distance from elarest w II_ _ _ _____-.DistancelfromJoundaf�n./Q............Material _`____________________ No. of compart nts--_ -------Size5XsLiquid depth___ __________________Capacity.a__ ___ . Disposal field: Distance from nearest w If�Distance from foundatipn�.-_-_......Distance-to nearest lot line__----- --- Number of lines_'________ ________ _ ___ Length of each line� _`3.5i`_�S, D.Width of trench----- _________.___---. Type of filter materia... r_ p .� �l _ �_� Depth of}filter materlal__�_�___ ........Total length_..-.`_��__ ____________�___. ` Seepa it: Distance to nearest eli LiK�Q______Distanc om foundation__'7.Q-_-_-•_-___-Distapce to nearest lot line____J�_____.. Number of pits--�. -----____--Lining material. QCk-----..Size: Diameter_//o7.............Depth------ 2- ...__...________ � Cesspool: r Distance from nearest well_________________Distance from foundation-------------------.Lining material ---------- ❑ Size:'Diameter- '`---•-----------------------------Depth-----------------------------------------------------Liquid Capacity............................gals, Privy: Distance from nearest well------__-------------------------_-------___-----Distance from nearest building-----------------------I ❑ Distance to'nearest lot line- -------------------------------------------- ----------------------------•-------------------•--------- ---- ----------------------------- L ------------------ ------ �1 `T dRemodeli g and/or repairing (describe}:_ -_. _. - -------------- ...... ...._. +�----- ------------ ------•--- ---••-----•- ----- - --•-- -------- --- ----•----- dLo------------------- ------•- rr��?? -- t *--------------------------•----------------------------- � �� ' , u� I hereby certify {hat I have pre4ared this application and that the work will be done in accordance with San Joaquin County O ordinances, State laws, and rles a regula ns of the San Joaquin Local Health District. ' � f (Signed)-•-- . ----- ner and/or Contractorl I gY� { s ttlt3l -- - -- ------ (Plot plan, showing size of lot, location of system in re! tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION..ACCEPTED BY---- ------------------------------------------ DATE..-----I (p -------------- REVIEWEDBY -------•-------------------`------ -------------------------------------------------------------... DATE BUILDINGPERMIT ISSUED----------------------------------------------- `- ----------._._..-------------- DATE.--------.-.--------••----•---------------------------------- # Alterations and/or recorpmencrafions____________ __ r__ ___ - ---------- �-- - - - •-------- = ----- I - E J = = F f I --•----------------E--r . . ---- FINAL INSPECTION BYA ..._.. . _. '' �:-`-----d.-1�-� I _ - --------------------•----•----------- Date-- --- •- •- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT f 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5'62 ATLAS d