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FOR OFFICE us . -------------------- ;_c9 t,_ APPLICATION FOR SANITATION PERMITPermit No. .:�. _ .!__` --------------------------------------------------------- (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued Date Issued ...L...... ..... 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. $1 or JOS ADDRESS AV LOCATI - - - - �_-- f --- O --- .•-n eC- . .4Owner's Name---. - e 7 - __ - {. �- r- -- r Address._-- ---------- Contractor's _--fContractor's Name. -----_7 -------------------------------•-----•------------_-----..------------------_---••---- Phone..............-------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ --- Number of bedrooms 3--- Number of baths ._:Z_ Lot size __1 _x_1. _.i.._._....._•............... Water Supply: Public system ❑ Community system Private [!] Depth To Water Table -------- ft. ,-Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W--gardpan ❑ Previous Application Made: {1f yes,date---------- ---------1 No ar-_'New Construction: Yes aj,'No ❑ FHA/VA: Yes [moo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest Distance from founda+iond,e........... ....... No. of compartments_----�---------------Size---..,'`-125_--7 -_-Liquid depth.....'1L----------------Capacity-Lf _4�9_ Disposal Field: Distance from nearest well-.-.-- Distance from foundation/0-r___-_-------.Distance to nearest lot line.!t.......... [ Number of lines........-----------------------.-Length of each line---7$,'_`--------------_Width of french---Zy_____•-----_----__------ Type of filter materia7-j4_-C,-*-----------Depth of filter material-14r_'-__-_--_.--.Total length-------- Seepage Pit: Distance to nearest well---- ----_-._Distance from foundation----t0.r.........Distance to nearest lot line____ Number of pits------�---------Lining material__34(,ll�---------Size: Diameter--23..............Depth-_---Asn'.--_ 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.-.--..--------_----_-•-----_-_--_-----.-. u ❑ Distance to nearest lot line---------------------------------------------------------------------•-----•-------------------------------------------------•--------------- V Remodeling and/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 regulatio of the San Joaquin Local Health District. (Signed)---------------------------------------------------------- ------ ------------ ------------------------------------------------------------------------{Owner and/or Contractor) By:.................... ---- . •. ----- ------ --- ---------------- --------------------------------------------------(Title)--------•------------------------------- (Plot plan, showing size of lot, location of ystem-in rely ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- =----- ----- . - ---•-------------------•----------- DATE--- = f_�.. REVIEWED BY--------------------------------------------------------------------------------- DATE ----- - BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- ._.... ---•-•-------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------- ----------------- � / / ` G-1~ r �� Date FINAL INSPECTION BY - ........... --- ri 130 South American Street 300 est Oak Street 124 Sycamore Street 205 w•sr 0}h Street Stockton,California ,•i Jodi,California Manteca,California Tracy,California REVISED S-54 2M 5-62 ATLAS