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FOR F CE,I�SE: 7 s '. / ��---------- - _--.--_ __________________________________---- APPLICATION FOR SANITATION PERMIT Permit No. __ :S-_k 2 -------- ----------------------------------------------- (Complete in Duplicate) �Z t Date Issued ---- ------------------ -----—----------- ----------- This Permit Expires 1 Year From Date Issued 245-02,0—C3 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. ✓h�1,��vs.9 ��/ — x�ii, fyiS�.ST G'o/ {�g�322.,£'".+`-t�-,�.��s�►�� JOB ADDRESS AND LOCATION--��=--�-------�p•�-----�-�8--•---•-----------------��yK-- ....5�.!A!-----X/r-•--------.........---------- Owner s -------- __7--- ---------------------- Phone_/5i2s1'5T �', ----- Address........C=.SF7hVO-_--------------------•------------------------------------------------------------------------------------------------------------------------------------------------- + Contractor's Name ?..........................................------.-------__. Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.../___ Number of bedrooms _�___ Number of baths ---L..Lot size._____.<2 p_____12x.&Zw__ _________________ Water Supply: Public system ❑ Community system ❑ Private 21 Depth To Water Table _�v--f?ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe® Hardpan ❑ Previous Application Made: (If yes,date--------.__.-------) No W New Construction: Yes ❑ No j?j FHA/VA: Yes ❑ No J TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank-'riN& Distance from nearest well-----------------Distance from foundation.........._.--------Material------------------------------------------------- ❑ f] I No. of compartments--------------------------Size----;--------------------------Liquid depth---------- ---------------Capacity....................... Disposal Field: Distance from nearest well--- oQ'____Distance from foundation-____ Distance to nearest lot line-----�13.`_- ® Number of lines----------- ----------------------Length of each line-------/a--P-!-------_.Width of trench----------A�_-•__--•-•----.-- Type of filter material....Ren-tti1C-------Depth of filter material------//-".......Total length--------------/pO-----_________--__ i Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line_-_______________ ❑ Number of pits----------------------Lining material-----------------------Size. Diameter----------------_---- Depth-_---.-_•-----------_____________ k 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----------------------------------------------------------------------------------------------------------•--•---------------•--••------------ - Remodeling and/or repairing (describe)-------/91,p.Q...... D........ --------------- ----------------------_...................... ! ---------••--••-------------------------------•-----------------------------------------------------------------------------------•-•------------------------------------••---------------•-------------------------------- --------------•----------------------------------------------•-------•--------------------•--------------------•--•-•---------------•---•-••------------•---------•--------------•------•----------------------------------- 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 regulations of the San Joaquin Local Health District. I (Signed)------ ------ : =----`-------`-- =---------------------------------------------- (Owner and/or Contractor) t By: -- ��1 -- `--------------------------------- -- -- ----- --- (Title){Plot plan, showing size of lot, Iota+on of system in relation to wells, buildings, etc., can be placed on reverse side). l FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------- DATE__. _ _. . ------------------------- REVIEWED BY = ---------------- DATE_.---- ---------------------- ----------------------------- --------------------------- - BUILDING PERMIT ISSUED...Z----------------------•-•----------- ------------------------•-•- ---- DATE------------------------------- Alterationsand/or recommend tions:---•------------•-------------------------------• -----------•----------•--------------------•--••-------------•----------•----••----------------------------- -----------------------------------------------------------------------------------------•-------------------------------------------•----•----------------------------------------•----------..---...----------------------- ---------------------- ._.__- : f ------------------------------------------------ ------------------- --------------------------------------- ------ -----------•----•--------------- ------------------ ----------------•-•-•- •......---....... xill FINAL INSP4ECTION BY: 9 Date--- SA JOAQUI LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak STreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS