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1-UKOFFICE USE: — ..�.. , ----------------- ------------------------_---_----_--- APPLICATION FOR SANITATION PERMIT Permit No. ..,1-�__ C ----------------------------- -------------------------- (Complete p e+e in Duplicate) ;----------------------------------- --------- ----------- This Permit Ex ires 1 Year From Date IssuedDate Issued —t Application Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Th's application is made in compliance_ ithCounty Ordinance No. 549. - _F_____ ____ __ f b � JOB ADDRESS AND C CATiON_ .�` Owner's Name_ i- Phone --/- -----------------------------•-------------- Address.......... /'ZZ,3 Contractor's Name__ ------------------•- ------•-- ..-- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ Number of bedrooms -;'- Number of baths .1-_ Lot size _1114r...h_� Water Supply: Public system ❑ Community system .❑ Private ® Depth To Water Table A0_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam W Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ a Previous Application Made: (If yes,date--------------------) No V ',-New Construction: Yes_M No ❑ FHA/VA: Yes ❑ Nd t TYPE OF INSTALLATION AND SPECIFICATIONS: v�� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_--------Distance from foundation- -D -•------...---.Material-_4��•.---•---...----•-•---- �] No. of compartments ' --Size--? s---- -Liquid depth---••- _-- --------.-Ca Capacity--t?®U - Disposal Field: Distance from nearest well-470-_-._-._Distance from foundatin __10---____.Distance to nearest lot line_-e�__--..._-_ 00 Number of lines-- _-A--- --------------- Length of each line--- .--------------•-Width of french--- Type of filter maferi 0 -- --Depth of filter material---/R-----__--Total length-----/k-V----_------------------- M -_-_--------------------- � Mit: Distance o nearest well �o:. ' ' f-------___Distance from foundation_-__f_.e_ '___--.Distance to nearest lot linevta .____-.--... C Numbs f - f.... .q------Linin material --------Depth 9 ..------_-size: Diamefer__te� - Cesspool: Distance from nearesf,well-----------------Distance from foundation--------------------Lining material--- ❑ Size: Diameter ------- __ - ------•------•-••--•- Q Depth ---------------•------------------------Liquid Capacity gals, Privy: Distance from nearest well------------------------ ------------Distance from nearest building -----••----------•--- ❑ Distance to nearest lot line - Remodeling and/or repairing (describe):_-.0 _ - --------•---------------------------- --•---- -- ------------------------------ ---••---•- -----------------------•--------••----•----------------------------------------- -------•--------------------------------------------•--------------•--------------------•-------- --------------- I I hereby certify that I have prepared this ap ation and that the work will be done in accordance with San Joaquin County ordinances, Sfiate S. and rules and regula+io the S Joaquin Local Health District. (Signed----- -- - --------551--- ..- �+...*- ---------------------------------------------(Owner end/or Contrector 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 BY__ _ ------------ _j------------------------ -------------------- DATE---1.714! - -------------------------------- REVIEWED BY--------------_ -------------------- DATE. BUILDING PERMIT ISS LIED ---------------- -------------------- DATE.......-------------- - Aerations and/or... recommendations:_}______________ -•---••------•------•----- -- ----- -•--- --------•---------•------------------•-------- ----•- �+� --- -- C --- ----- - �---�l�L• . - a--'.--�� - ' -af�c: _. ---------------------- -------------•---------------------- FINAL INSPECTION BY--- - - ---- - -- - -- Dete ( ----------------------------------------------------------- --- --------------------- y SAN JOAQUIN LOCAs. HEALTH DISTRICT 130 South American Street 300 West Oak Street' 124 Sycamore Street 205 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS tea..