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FOROFFICE USE: - ---------------I—-------------------------- ------------- -----________----------------------_-------------- APPLICATION FOR SANITATION PERMIT Permit No. ... .1� . ?_ �- } (Complete in Duplicate) �S This Permit Expires 1 Year From Date Issued Date Issued ..............!_.._.. F-02- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in cormplian�e with County Ordinance No. 549. N JOB ADDRESS AND Aj�----`�1 ii-�=�---.1?�-•- 71_ F CKS _ # Owner's Name---------... _.L _.------- ��Tr-'--- - ------------------- Phone....!�.:AL�."}....... Address ��T �6-......-----------•-•-------------------------------------- -Contractar s Name1d�f\-, .. _ -•-------------)Phone.............. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ ____ Number of bedrooms ._ _ Number of baths 1 ' �y 9 . Lot size Water Supply: Public system ❑ Community system ❑ Private e Depth To Water Table --5—ft. _ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam El'—Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑� (!J Previous A lication Made: llf es, ate ................] No d�Jo❑ FHA/VA: Yes _ N6-p- - pp y New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----5 0.__Distance from foundation----/ -------Mato iai___ - No. of compartments____-_�'______________Size.�Al _x_!57_Liquid depth__... ---------- Capacity.l - - Disposal Field: /Distance from:_nearest well ___Distance from foundation-----fQ-------Distance to nearest lot line... Number of lines.#-----/-----------------------Length of each R. line______ ? _____�T__..Width of french-------- _ _____...__..___ -Type of filter material._._ Q CK__Depth of filter material------- length.._ _lam ______-_-..__ ___--.__....._ Seepage Pit: �. Distance to nearest well______---------------Distance from foundation-----------.-------.Distance toynearest lot line__-._._---_--__-_ ❑ .Number of pits-_'------------------Lining material_----------------------Size: Diameter____......_______.___ 'Depth:__-__....-_-----.-.--------___-- Cesspool: '; Distance from nearest well_________________Distance from foundation---------------------Lining material............._______._______--__..--- ❑ �' Size: Diameter.---.------------------� N : ;---......Depth----•--------------•------------- -------------..._Liquid Capacitly-. gals. Privy: - Distance from nearest well-_______________________________________________Distance from nearest building-----------------------_------------------ ❑ Distance to nearest lot'lined'______________________________ Remodeling.and/or repairingt(describe):----- ll_(,P��. �..._�_._..�A��.--'----��0/��*•-�-------f------------------------------------- ................... .....•-•----------..._.. •------------•------------------------------=---------- ---------------------••------------------ -------`-�"----------------------------------------•--------- ~"' I - . ' ......:.: ..................."-----•----------- I hereby certify that I have prepared this application and that the work will be done in'accordance ith San Joaquin County ordinances„State laws, and rules and regulltions'of•the`San Joaquin Local Health District. } (Signed}" --------------------------------------------------- -----~------ - ---------------- -----------------(Owne a door C no frac+oi}. i � . ,r y(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. ._ _.__-7- - --- -I---�---�-�---��----'---------------------------------•----------•------•-•------- DATE.-------- RE ------ --'��-�._,.'.�-�---�-- REVIEWEDBY-------------------------------------- --------------------•---------------------------------•-- --------------------•--- DATE--------••--•-------------_-_ ',BUILDING_PE,RMIT ISSUED------------•------------------ -----•„••----------------•----------- .DATE f} Alterations and%or recommendations---------------.---------- --------------•--------------•-----••-------------------------------------------•----------•-------•--•------- --------•-------------------•---------------.... ----------------------------------------------------------------------------------------------------------------- --------..---•---------•-----------•-•-------------..._ F < } _ ! ! - - ----•-•-----------------------•---••-------•----------_------------------------•----------••----------------------- FINAL INSPECTI Date---____--q--~ .41 - --------- -- -- - ------- --- - f 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South'Arnerican 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-$2 ATLAS #1