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FOR OFFICE USE ---------------------------------------------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. .. `5,� ..� ---------------------------------------------------- (Complete in Duplicate) Date Issued ..__.__�Y/ ..................................................... I 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. JOB ADDRESS AND LOC ION---------------------------- S.7/ --- - ------- Owner's Name------V! - P •--!�.--'--•-- --• --------------------- -- - ------------ Address.........I'` � / .. �'v -- ---•- s� Contractor's Name..._.-___... _ hone_ ... `- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i s Number of living units: __I_-__ Number of bedrooms ----1. Number of baths Lot size -------__ --------- _-------------- Water Supply: Public system ❑ Community system tg Private ❑ Depth To Water Table 1.7- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam F] Clay)V Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date!_'1__"/P_a___.) No ❑ New Construction: Yes ❑ NoX FFANA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: rt. (No septic tank or cesspool permitted if hpublic sewer is available within 200 feet.) Septic Tank: Distance from nearest wellt��__ _Distan f foun�tion-------�._d_....Mate i _ -'!�-!��Z?�->___._. ----- No. of compartments-----il----------------Size.`/ �____ _.�_.___Liquid depth__.___.__..:. .._..Capacity.1Q______ Disposal Feld" Distance from nearest well_________________Distance from foundation__..................Distance to nearest lot line................. t Number of lines___________________________________Length of each line__.................._---------Width of trench................................... Type of filter material_________________________Depth of filter material------------------_-...Total length.......................................... Seepage Pit: Distance to nearest well------------_---------Distance from foundation........._.......__.Distance to nearest lot line................. p 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 to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- rJ Remodeling and/or repairing (des ri e):--t ------- ---- ----- ---------- ----- - Ott---------_-- r ---- I hereby certify that I have prepared this application and that the work wi be done in accordance with San Joaquin County ordinances, State laws, rules and re tiojT the San Joaq ' Loc District. Si reed ( 9 ) --- -- ------- - ----- ---------------------- (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 DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------------------- ---------------------------------------------------- DATE------------------------------------------------------------ REVIEWEDBY----------------------------------------------------------------- ------ DATE------. ................................................... BUILDING PERMIT ISSUED--------------------------------------------------------------- ---------------------•------------ DATE........................... ...............................Alterations an /or recommendat' s---------------------`_---------------_--------..-_-- -.- ._____- ............. ---- ---------- .. -.-- --- � - ---tie.... r s.. 'l �,ri..:_. �e.Q...4../ FINAL INSPECTION BY--------------- ------------- - Date-- 1 '" �/ ------ -------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLAS