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FOR OFFIC �' ..�.3_.____. ' _ APPLICATION FOR SANITATION PERMIT Permit No. ..! q --------------------------------------------------- (Complete in Duplicate) O Date issued ___ 'J --------------------------------------------------------- This Permit Expires 1 Year From Date Issued �_ __6 Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549.` e s JOB ADDRESS AND LOCATION ----_--_ ........... i�l.�! ... Owner's Nnme _ i< '_ ------------ -------------------------------------------- Phone-- Address.................f S-4-2 F • Contractor's Name---------- P.- .......................... Phone Installation will serve: Residence ❑►' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.❑ Number of living units: _/-___ Number of bedrooms 7--- Number of baths __ Lot size _____:7 .......... Wa+er Supply: Public system ❑ Community system ❑ Private �epth ro Water Table _SO_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ff"Hardpan,❑ Previous Application Made:, (if yes,date--------------------) No®- New Construction: Yes ❑ Nop- FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: f r' ,.(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation___________-___--__.Material______--____---__----_--__--------_-_____-____-. k ❑ No. of compartmepts--------------------------Size-----.---------------------------Liquid dep+h-------- -----------------Capacity------------------------ Disposal Fiel Distance from nearest well_- _ --_Distance from foundation_____3_ ____Distance to nearest lot line.._-_ _...�_.: ® ��?-� Number of lines___ ____ --------------------_Length of each line------------5-P...........Width of trench...........�:-Y:...'_.......... i [ Type.of.filter material._. 1'Q"t'C-----Depth of filter material----------------- length......................k'S3'�'.'......... Seepage Pit:k Distance to nearest well-----e _`..__Distance from foundation____ to nearest lot line.... ........ ® j m Number of pits----------r---------Lining material__ 20.CZ4____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 and/or repairing (describe):------ i ---------. T------ S i41¢-----------;T��Si�'/�� .................................. ' ------------•------------------••-----•----------••--•--------•-- • ----------•--------------------------------------_------•-------------------------------------••------------•-----.-------------=----- ------------- ------------------------------------------------ =---------------•--------•---------.----= --- -•--------------...- -------•-----------•----------------- -----•------------- ---------------------------------------------------------------------------------------------•-•----•-----.----------•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations/of the San Joaquin Local Health District. �,�-- Cc -� R----- J- ------------------------ -- Owner and/or Contractor (Signed)------------- - -� �_ -------- -- --- - - --- - - - -- - --( / 1 By:-------------- i ✓0 ------------------.-----------------------_-.(Ti+le) ------•---.... --- ------ ------- (Piot plan, showing sire of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED. BY -------------------------------------- DATE_-1_11r�•• _ -._-._.----- REVIEWED BY-----------1------------------------------------------------- ------------ --- ------------------------------------------- DATE----------:�-•------- .._..-------------------------------- BUILDING PERMIT ISSUED _ - TE-- - - --------------------------------------------- Alterations and/or recommend'a+ions:- - �� h�..l___ _____ __may_ i -_.---•-------•------------------------•- - ------------------- � ------------------------------- -._(O............. :....: -. --------------- -------------------- ,_ ------------ 4% -------------------------------- ---- ----------------- ............. -- ---------------'------ ----------------•---- ---- - .. ------ 7 ----- FINAL INSP N BY�----- - --- ---- - ------ ate--- ---------- ------- ------- ----- li AN JOAQUI OCAL HE TH DISTRIC 130 South American Street 300 West Oak eet 124 Sycamore SI 203 Weil 9th Street Stockton,California Lodi,Call rnia Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS i