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FOR OFFICE USE: ., - w ?/-el. 1 W — --------------f APPLICATION FOR SANITATION PERMIT Permit No. .. .. ------------------------ -------------- (Complete in Duplicate) y Date Issued __ ----------- 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. 6SO4, K_E,cJAJl--FEGic r -,I,. y`7"i JOB"'ADDRESS AND LOCATION ._.. ... Owner's Name.--------------4 ------- ------��` '"'"i----------------- ••------------------ Phone.................................... Address-------------•jevl 00 Contractor's Name -•-- - �:-t-�• >�� _ �t� ----------------------------- Phone................................... Installation will serve: Residence ID Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .!----- Number of bedrooms __3__. Number of baths _ Lot size _ '_._-f_0__________________________ Water Supply: Public system ❑ Community system ❑ Private ® Depth To Water Table 1_a-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam g] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote--------------------I No W New Construction: Yes a] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ft - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.x 0__.___..Distance. from foundation-_-/_0..........Material_____ ______________________ No. of compartments____. --------------------Size-V--?. �_ ., ;---Liquid depth-------- --------------.-Capacity_- - !�'�----- Dis o al Field: Distance from nearest well-4- -'__ -Distance from.foundation._.1Q_ ........Distance to nearest lot line..rl........ ' [ Number of lines______________ _____p__..___ Length of each line_._�4--_OO_________ Width of trench-_-.A-_Y__."...---------------- Type of filter ma- 21 --_-- _____- Depth of filter material____1.I-_`..____-. Total Iength__,7-5e p- __--_____ Seepage Pit: Distance to nearest __________________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_________________-__________.._..._-_ ❑ Size: Diameter------------ -------------------------Depth---------------------•------------------------------Liquid Capacity-----------------.--------gals. Privy: Distance from nearest well--------------------------------------------_....Distance from nearest building.____-__-_________._.....____________._. ❑ Distance to nearest lot line----------------------------------------------------------•-••-------------------------..._.__.-.•--------•-••----------••-------------------- Remodelingand/or repairing (describe)------------------------------------------------------------------ -------•------------------------- ---------------•-•-----------•-•------------•--------- ---------------- ----•-•------------------------------------•--------------•--------•---------------•-••----•------------------•-----------..-..----------------------------------•----•------------------•------------------ --•--------------------------------- -•---------------------------------------- ------------------------.--------------------------------------------------------------------.---------------------------.. hereby certify that l h ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ules a &rulations of 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 DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y,,/k1,<7_-,1- ---- - ------------------------•--•--------- ------ DATE_,1__-f/M----'3--------------- ----------------- REVIEWEDBY----------------------------------------------------------------------------------------------------- ------•---------------- DATE.----...-----------•-------•-------------------------------- BUILDINGPERMIT ISSUED---------- -------------------------------------------------------•------------------------------. DATE------------------------------------------------------------- Alterationsand/or recommendations:------------------------------ ---------- ------------------------•----------------------------... ------------------------------.._...------------------ t -------------------- --------------=-----------------------------------.-------------- ------------------------------------------------------------------------------------:-------------------- .,._.--------------------- --••-•---------------•_.............-- -----------------------------------------------I-----------------------------------------------------------------------------.-------------------------------•------------------------ F1NAL INSPECTION BY:..-ice - - ------------------------ Date....��-5-�-�'--`�-----...------.----------------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street p Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59214 5-62 ATLAS M