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FOROFFICE USE: --- - -- --- ---- ------- ----------- ---------------------------------------- -----....................__-..-----..---_--.-_.__----- APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) ----------------- --- This Permit Expires 1 Year From Date Issued Date Issued ._.__.....1_.y�1�3 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 Ord' inancer%No. 549. JOB ADDRESS AN LOCATIO //T��` , - �J-�--------------------------------------------- C-................................... Owner's Name_ .__ •___•___• _ -------------- - ------------------ x � 7 Address.....2`�_l'��.._�c > r -------- . ... ---••-••---•-•----• -•--- . • ••-••-• •••• ..�.t 4�. Contractors Name •---- � ' . ------.-- rte.7�Fh6Tie...............•' Installation will serve: Residefic�e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._----- Number of bedrooms ---!---- Number of baths ....j_. Lot size ......�1l.��IQ._ ..�.!Zp....................• Water Supply: Public system El Community system Private [:1 Depth To Water Table ..�_�T t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay X Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date------------------) No U< New Construction: Yee, Z_,No E] FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well_________________Distance from foundation....................Material................................................. 54 No. of compartments--------------------------Size--------------------------•----Liquid depth--------------------------Capacity....................... r_, Disposal Field: Distance from nearest well...�0_:�-Distance from foundation...../.5 Distance to nearest lot Iine_A0 ..... W t Number of lines_....__..... Length of each line___�o___...�.y�f_...Width of trench._r,_-Z6 ..Fi.................... g S�� Type of filter material..�� _Depth of filter material.-•____¢-___.._.Total length---,,15-0- -.....•...___....•........._ eepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ 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 Remodeling an /or repairing (descri e):_c/ ..� _ d ��-C-� '. Cf / iz '----------- c .....Wt. ----------------•---•--------------------------------------••---------•-------------------------•---•---- .--- ---- .. ---------------------------------------------•---------------------------•----•------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. --� (Signed) -----------------------------------------------------------------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Trifle)------------------------------------------ -------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be places on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE.......................... --------------------------------- REVIEWED BY--------------------------------------------- ---------------- _ DATE...1:rr:n .:e4--3.......................... BUILDING PERMIT ISSUED DATE-------------------_---------------------------------•---- Alterationsand/or recommendations:------------------------------------------ -------------------------------------------------------•----•-----------------•-----•------------------------------- ------------------------------------------------------------ ---------- -----------------------------------------------------------••-•-••--••••••-••---------•••••••----•-•-••-••••••••--••-••-......--•--•......-- ......................... ...........••--•......------.....----••. •---------------------- ....................................................... ........................... .._._.....••••-•---•---•-••••-- • ------------------•------------------------------------------- ------------------------------------------ --•-•-••------•• ......••---•------••-•------•••-......------••---••....•--•- - -- - ------ --•--- ---------------------------------------------------- ----------------------------------------------------------•-- FINAL INSPECTION BY---------- ---------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wort Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS