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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . .�. ..-��` ----- ------------------------- ---------------------- (Complete in Duplicate) Date Issued ---_G. S-•/3 ----- ------- --------------------------.--- 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 A LOCATIO , f .1t�X-� `- _ •-{- �'__ x-_/-�2c'.--- � _._ _._�'_Owner's Name..... �.0� .��---. ��'-=:�-z.�::4�-----------4--f- -�-�---�--�------------------------�-------- Phone- ..-.. >l Address__-- ..-- ' N Contractor's Name_sJ -e.�. .. 1 :�J'ls 1 �_�.f-f ..Q.�IIJ :-+---------------------------------•-----.-._...---. Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other W 64,1� Number of living units: _'�. Number of bedrooms Y.- Number of baths __�9= Lot size ��.._..___---_.- Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 01-,New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well�O--__-_.Distance from foun�n__/K._.._-��ateri l_ -Iv__rt:.��_�-�_�-�` fl No. of compartments-- --Z- _ depthCapacity../__ -e9n..--- Disposal Field: Distance from nearest Distance from foundation��./_....Distance to nearest lot line_�_� "._. Number of lines_-------------------_---_Length of each line_f Q_a.._._gip i.Width of trench--_-. ..'� --------- Type of-filter-rneterial�jiLa-�_, _-Depth of filter material..t -!----_--- -_Total lengfh--------- ............. 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-----------------Mstance from fo�iridation--------------------Lining mate-ria' l------------------------------------- 0 - Size: Diam ete'r —--- ------Depth------------------------------------=--------------Liquid Capacity----------------------------gals. Privy: Distance, from nearest well------------------ _-_.----_----- -----.-Distance from nearest building.---_---.__.---___--____---_----.-------. ❑ Distance to nearest lot line--------------------------------- -------------------------------------..-..-------------------------------------------------------- ------ Remodelingand/or repairing (describe)------------------------------------------••-•----•--•----...-------------------------------------------------------•----------•------------------------- -------------------------------------------------------------- -----------------------------------------------------------------------------------------------------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. w 1 ell (Signed)-,- cr: 6'-•`-i! - . .....e ---------------------------(Je641*v"er Contractor) By:------------ ---------•---- ...._..--------------- -----------------------,c -G .. (Title) (Plot plan, showing size of lot, location of system in rel- ion to wells, build' gs)tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ R�-Q--- ------------------------ -------- --------------------------- DATE-----�--_ ` �� -------------=- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE-------------------• BUILDING PERMIT JSSUED - '= ==- A�--- ----------z---==-_----- =::___ _DATE -- ------=--------.-: Alterations and/or recommendations:----------------------------------------------------------------------------------- ---------------------------------------•----------------------------• ---- FINAL INSPECTI BY- - - b� Date v --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strout 124 Syeamori Strait 205 West 911h Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS