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FO OFFICE U E: A r � � s Permit No. / `--(... " � . APPLICATION FOR SANITATION PERMIT -.. - 7 (Complete in Duplicate) ----- Date Issued ..... This Permit Expires 1 Year From Date Issued ict for a permit to construct and install the work herein described.Application is hereby made to the San Joaquin Local Health Distr This application is made in compliance with County Ordinance No. 549. 7'r � � f1 it - r (_� �/ �'17it . ,a------------------- JOB ADDRESS AND LOCAT�N_.�c-•------ ----------------------•----•- ---- - • •-- �,•� Owner's Name ---------------- Phone- ----•------------•-------------------------------- Address.--_. •-- _ -----------------------•---------------------------------- .. ; .-Contractor's Name __ L `} ...............'o#el one..Other ------•--•- � c Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ M ❑ ❑ Y ---�- ----------------------_------- 4 - ------- tF Number of living units: -------- Number of bedrooms Number of baths ___.___• tot size .- -- x--- ---•- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table - � ft. Water of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑10 Clay Loam ❑ Clay ❑ Adobe�Hardgan ❑ Previous Application Made: i.(if yes,date------------------ -) No e New Construction: Yes [�r No ❑ FHA/VA: Yes ❑ No ®' TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep�8'n4 Distance from nearest well_________________Dis#ante from foundafiion____.._.__.-.-__-..Material___"_____---__.___-------..-.--•-•--------.----- � No. of compartments---------------------------Size---------------------------------Liquid depth----...__...--------------CaPacity....----------------•-- Disp I��y Distance from nearest well--:-�'_f__--Distance from foundation�.�4'.�.........Distance to nearest lot�line_5.�--.••..- \ p 1 Number of lines...-J----------------------------Length of each line_r�__-------------------Width of trench.z� -•-----•-------------- a � Type of filter materiall�_S� ""-----Depth of filter material_1 �- ---------Total length-----�iL -------------------•--�---- See pa Pi#: Distance to nearest well____________---------Distance ' ,om f undation.�a.-----------..Distance to nearest lot line... 17 - Number of pits____---------------Lining material_:_�Q,L-- -------Size: Diameter---i- .--_-----Depth_.__.--- i .............•.- earest wall____.___"___..__Dis#ante from foundation__-.---- Liningmaterial Cesspool: Distance fromingals. ElSize: Diameter:I-----------------------------------Depth-------------------•- ---------------------------• Liquid Capacity--------------•----------•- Privy: Distance from nearest well----------------------------------------------- Distance from nearest 6uilding------------------------------------------ ❑ ------------------------------- Distance to nearest lot line------ ------ ------ --------------••----..'..--------------------------'-----• R odeling and/or repairing (des � - - ----- •----- ••-- _ > ------- -------------------------------------- ----- - ------------------------------------------------------- ---------------------------..._._------------------------- ty 1 hereby certify that I have preparedA- cationnd that the work will bedone inaccordance with San Joaquin ounordinances, State laws, and rules and regn Joaquin Local Health District. St ned _ -------------- ----•------- -----------(Owner and/or Contractor) ( �9By =---•---------------------------------- Title --------------------------------------- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). " FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.---v___________________-_ -------------- ----------•• - DATE-_---7 .1- ------------ REVIEWEDBY----------------------------------------------------------------------•-------------------------•------- -- DATE------------------------------------------------------------- BUILDING PERMIT ISSUED----------•--••--------_----------- ---------•-----------_ ---- -------•------------••-------- Alterations and/or recommendations:- ----------------------------------------------------- ------•---------------..--------------------....... --- ••--------------------- --- •-------------- --- I -� _______________ ___r _.-f..._..._._._.-___._..._______. ._. /�_ ------------- PINAL INSPECTION BY....... . . ._ ..�-4_��t�----------- ------------ Date----------�-�f� �-�- --...---------...------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 south American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9.59 2M 5-62 ATLAS