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FOR OFFICE USE: J" ` di i - APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) T /--- --- This Permit Ex fres 1 Year From Date issued Date Issued .. 7. . �S 3 _ _y , Application is hereby made to the San Joaquin Local Health District for a permit to construct ari*install the work herein described. This application is made in compliance with County Ordinance No. 549. w� l JOB ADDRESS A LOCATION_ f :-- �z�r 3 Owner's Name-- __ �'�rL� ` j ---•--•--•-----••---------•----•--------------•------------------------------- •------------------ Phone --------------------------------- Address --- ------------------------- Contractor's Name------------------ ---- ..........-----------------------------------------------------•------------- Phone................................... Installation will serve: Residence [��Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: _�----- Number of bedrooms--_- Number of baths :�_ Lot size .?--._-.�3/c:S /V - -------------•- Water Supply: Public system [ICommunity system 2`�Private El .Depth to Water Table ...... ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Se dy Loam ❑ Clay Loam [:] Clay E] Adobe Hardpan C] I .� Previous Application Made: (If yes,date--------- ........) No New Construction: Yes [?"No ❑ FHA/VA: Yes M-- No ❑ -� TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.)Septic ank: Distance from nearest well---: �---Distance from foundation-Aye------- Material.--- A64-+fit --__---•- Cy ` No. of compartments-._ ..--___.----.--_Size.___MJ�"�r•--fC_`_0--:--•Liquid depth----._- _-i----_-_____Capacity-.,� a:�" CN Disposal Field: Distance from nearest well. --- fi ---_------Distance from foundation-1,D-f-....._--.Distance to nearest lot linei?�...�-____. Number of lines---------_- _-,-_------------- Length of each ----------- of trench-��:--y-- ----- --------------- Type of filter material.]?e,_- --------Depth of filter material__.`,K _---....Total length---I�_/_•--_-_____-- _--___- , Seepage Pit: Distance to newest well-------.'r'-----_Distance from foundation------19_r.. .-_.Distance to nearest lot line___6_._. i ®� Number of pits-----L-------------Lining material--.�.C_A,,----Size: Diameter-._-33_r---------.Depth------24................. 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------------- __----_--_•---. t ---------- ❑ Distance to nearest lot line-- ---------------------•---------------------- ----------------------------------------------•----------------------- Remodeling -----.----------------Remodeling and/or repairing (descrbe):------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------••---------•---•----------------------•--•---------•----••------•---•-------•-----•--------•---•----------- { - -----------••------------------------------•-- ---• --•-------I--------------------------------------------•-•-----------•----------------------.-.._------------------------.---------------------------------------- I hereby certify that I v . prep ed this application and that the work will be done in accordance with San Joaquin County k ordinances. State laws, and ul s and 1 egulations of the San Joaquin Local Health District. (Signed)--------------------- ---------•- . -- -- - - -- -------------------- ----"---------------- -------------------- (Owner and/or Contractor By:.--------- ...... -- -------------- ;------- ---------------------------------------------•-•--------------------------(Title)-----------------------------------.-.------ ..-- ---- ----- --. {Plot plan, showing s o ,,location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y - ---•-----------•--•--------------------- DATE-- r �L- REVIEWEDBY-------------------------------------- -----------------•--------------------------------•------------------------ DATE BUILDING PERMIT ISSUED------------------ -----•----- -_ -A ------ DATE ------ Alterations and/or recommendations:-_ teA — 11" ----•----_•• -.-- ----- ------------------------•---------•------------------•-•-----------•---------------------- --------------------------------------------------------- ------------------------------------------------ ----------------- ---------------- ....................... ................................ -- i FINAL 1NSPECTION-B.Y: _....." .... - - --- --- --- _-- SAN JOA W LOC HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodl,California Manteca,California Tracy,California E5 9 REVISED 8-59 ZM 5-62 ATLAS 1.41 s