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FOR OFFICE SE: AQ xr- /s- 73 -------------- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ............._.: ---- ------------------------- --- --------------------------- (Complete in Duplicate) ------------------ This Permit Expires 1 Year From Date Issued Date Issued .....__. ...__..�c• Application is hereby made to the San Joaquin Local Health District for is permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 54/y. ;103 41 F- "L f' S7` / JOB ADDRESS AND LOCATION.._+'_-41__ rA-_. Owners :_!Name � I-.4_: ----------- Address-- -`- w ( '. ----------- Contractor's Name ---------------------------------•--•-----------------.....---...--------..-...--------------.-....-------------------------------- Phone................................... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ pz, 10'7 Number of living units: ._A7-_ Number of bedrooms .-$, Number of baths 2,_-_.Lot size al/._0 __- f Water Supply: Public system [Community system ElPrivate ❑ Depth TO Water Table -------- ft, f ] Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote---------------- ---1 No [ New Construction: Yesj]'No ❑ FHA/VA: Yes ❑ No [ice'- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic,Tank: ;t,� Distance from `~ nearest well--- Distance from foundation_..__la---.....Material-t .�----- ------------ PT No. of compartments-----ZZ---------------Size---- _15.. x- --------Liquid depth------4. .-_____--Capaci e W tY---- r Disposal Field: Distance from nearest well-_� ----Distance from foundation._/v._._.-•----Distance to nearest lot�line................. _... Number of lines_._-_-----�------------- -------Length of each line------ Width of trench.-.=Lf--_-- ti--- Type of filter material._.'Cf&__---__Depth of filter material..__,(k_-y---------Total length...#._P...••-----------------•---- I r\ Seepage 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------------------------------- .-. -----_-----.._-_. -.----. �Zt ❑ Distance to nearest lot line------------------------------------------------------------------- Remodeling and/or repairing (describe):------( _t_ # �� l � g�� . " 1 -------------------••-- ---------------------- ---------------------------------------- , -------------------------------------------------- ------------------------ ----------------------------------------- --------------------------------------------------------------------------------------------------------------------------- - I hereby certify that I have pSepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of th San aquin oval Health District. (Signed)---------------------------------------------------------------- ------------- ------- ------ --------------- ------------------------------------------(Owner and/or Contractor) By-------------------------------------------------------------- --- ----- -- ----------------- - ------------------------------ (Plot plan, showing size of lot, location of s m ation to we s, buildings,*etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B0 . - DATE f - .. REVIEWED BY-------------- ----------- - �-- ------------------------/---------------- DATE BUILDING PERMIT ISSUED----- --------------------- ------------------------- ----—-------------------------------------- DATE------------_- Alterations and/or recommendations------------------- -----------------------------------------------------------------------------..... ---•- ---.-.... -------------------------------------------------------------- FINAL INSPECTI ------- ----- Date------ f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS i