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` FOR OFFICE USE: ---------------------------- -------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ._.. 1 � � -------------- --------------------------------------- (Complete in Duplicate) - --- This Permit Expires 1 Year From Date Issued Date Issued ... Application is hereby made to the San Joaquin Local Healfh District for a permit;to.construct end install the work h rein described. This application is made in compliance with County Ordinance No. 549. ��-}-� { JOB ADDRESS AND LO ATION-: A.l T-15_-ter__ __.: 1�� :_�✓JI__" 1... � _f_ I E�! -_..�� Owner's Name------ ------- --- FE& -._ �1 - _: = ---------;----•--- ------ Phone_..-------- Address--------- ® Rj.. H__ � _. h - m. x..- Contractor's Name_f-><L 4'! ...........I------------------------ Phone..................----- Installation will serve: Residence W�-Apartment House ❑+ Comrnercicl ❑ Trailer Court ❑ +Motel ❑ Other ❑ Number of living units: J,---- Number of bedrooms�Z_--'Nur;9er of baths /-.___ Lot size -fie t�A_ �____________________ Water Supply: Public system ❑ Community system ❑ Private 9?`bepth To Wafer Table Z-5-74"i ,V.#, Character of soil to a depth of 3 Meet: Sand E] Gravel [J Sandy 'foam Clay Loam ElClay ❑yAdobe Hardpan Previous Application Made: (If yes,date.................... No 12- New Construction: Yes 4 ❑ HA/VA: Yes ❑ ' No.Fr TYPE OF INSTALLATION AND SPECIFICATIONS: % (No septic tank or cesspool permitted if public sewer is available within 204 feet.) AA Septic ank: Distance from nearest well___5-®___Distance from foundation-----/92-----Mater' I._ 1 - No. of corn partments-.__- -----------Size__1�_•-X _ .. _.---Liquid depth---------- - Disposa Field: Distance from nearest well_.-.,5 Distance from foundation_____._ __ �f-___._.Distance to nearest lot line------ Number of lines_____-._/___ ______________Length of each line__:__�?�- Width of trench_!.._ -- -- 11 Type of filter rrtaterial._._ CCj'�_.__Depth of filter meterial:____ !I . I _�r_____Total I ngth""s ................ Seepage Seepage Pit: Distance to nearest well-----------------Distance from foundation---------------..__-.D.istance to nearest lot line__--•-__-____ ❑ Number of pis--- -----------------Lining material-----------...... ----Size •: Diameter___•_._.... ►_..Depth_-----------.•-----•----- ---_-_ T,, - iw11 r Cesspool: Distance from nearest well-----------------Distance from foundation-----------_.-------Lining material-------------- --_.-____- ❑ Size: Diameter Depth t ---------------------Liquid Capacity--------- --------------..gals. Privy: Distance from nearest well_______ _"Distance f 4 rom nearest'buildin 9--------------------------------------- ❑ Distance to nearest lot line =--�---------------------------•----------------------•...------------------ Remodeling and/or repairing (describe):----------------------------------- ------------------- ----------------------- I ---------------*------------------------•-------•-------------------- --- ----------------------------•--------------------------------------------------------------------------------•------------.._-..------------------------ I hereby ce ' y jhat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Ste aws," nd'rul' n eguI ions of the San Joaquin Local Health District. F /J (Signed)_._ 'L_ ��lt _ -------------------(Owner and/or Contractor) 13y:. `' --------------------- (Title)---------------------------------=_ (Piot plan, showing size of Iot, loc ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY € �1` r ---------------------- DATE.----- �- REVIEWED BY •--------------------- - DATE - -• -----•---•--------------------•------...--------••-------- BUILDlNG PERMIT ISSUED -- ------- - ------------------------------------------------------ DATE = _ ... .... Alterations and/or recommend'ations: __________ _______ ____ T ^� -=-- ----- `•--------------------------------------------------------•----- t 4r't ti **.. r ------------------------------------------------------------- --•-------------------------------•------------i---------------------------•-•------..-....--•-----•---------------------•- -----------------------•------ t '4h* ------------ -- -- - FINAL INSPECTION .----- - .- _ - - . - -- tDete- ---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f CS 9 REVISED 8-59 2M 5-62 ATLAS 1