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FOR OFFICE USE: y� ------------------------------------------------------ ! APPLICAThs!� FOR SANITATION PERMIT hermit No. (Complete in Duplicate) Date Issued --- ------ --------------- ------ -------------------------- __- ---- ------------------------------------_-_-____.--_ This Permit Expires 1 Year From Date Issued % 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. �,1j f0I��—) 00 -2S JOS ADDRESS AND A ION_________ / ��} __ _ ~ .. .- t1°�-''e� ._ � Owner's Name------------- L.d,/1__�'.�------------------------------------- -------------------------------------- Phon .._. .�../��73 Address----------------•--.........� -------------------------------------------------------------------------------------------------------------------------------------- ------------- Contractor's Name__ ......... A Q �. _=�� ---- --------- = Phone Installation will serve: Residence --_'Apartment House Commercial ❑ Trailer Court ❑ Motel 7' Other ❑ Number of living units: _-_!--_ Number of bedrooms _ _ _ Number of baths _-/-__ Lot size ....... ---••-••--------------- Water Supply: Public system ❑ Community_ system ❑ Private (Depth TO Water Table f-/_. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes 5r�_No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pub[ sewer is available within 200 feet Septic Tank: Distance from nearest w II_�Q�II' Distance(from �aupnda#ion._ __ � via#eria�_---CMP-------- .. --- No. of compartments---- --------- - Size. .- -Q� -6--._--Liquid dept}t_________ ----------.Capacity... - --•----_gam e t M n Disposal Field: Distance from neares well_ZhU Distance from found tion-_I�...&##,Distance to nearest lot lin __s7/_fie fx, Number of lines._....3_______ ____________ _Length of each line& . _1Q� Width of trench_._-. -. -11--------- k" of filter material.5l° -roCR—Depth of filter material-----___--./_�-----.Total length_-��______________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation------------._.._•_.Distance to nearest lot line----------------- a 1(N ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------...----Depth--------------------------------- w 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-____________._.__--_-_-______----------. ❑ Distance to nearest lot line----------------------------- ------------------------------------.-------------------------------------- ----------------------------------- Remodelingand/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 aw s, and rules and regulations of the San Joaquin Local Health District. (Signed)------ ---44....� -------- --- - --------------------•----------------------------------------------------.-.(Owner and/or Contractor)' By:_------------------------------------•--------------------------•-------------------------------------------------------------(Tiitle)----------------------------------------- - ------------- (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------------------------------- --------------------------•--•------- DATE------ ✓ ---------- REVIEWEDBY----------------------------------------------------- ----------------------------------------------------- ----------------- DATE-------------------------------••---•-------•------------ BUILDINGPERMIT ISSUED------------------------------------------------------------•------••------------------------------- DATE------------------------------------------------------------ Altergtions and/or re ommenc ation ------- --------------- -------------------•--•• ---- - ............ --- ------ �.-=�aJ�' `f------------- G .�JZA�I�_._'_--- .... --------`--------C` '--•---------------------------- ---•---------------------- FiNAt INSPECTION BY:............. 7 -- ��'�Z �`'v� -----• Date-------- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 911%Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 2M 9-62 ATLAS "'