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FOR OFFICE U E: - -- _ APPLICATION FOR SANITATION PERMIT Permit No. _!_..?0.5....... {Complete in Duplicate) h ---•-- ----------------------------- ---------------- - Date Issued r This Permit Expires I Year From Date Issued f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This appli ation is made in com Iia= with County Ordinance No. 549. E JOB ADDRESS AND LOCATION-------- 'Is- um;I- ---------------------- - o � ... - -- L ' 1 — Phone................................Name-----------•--�°-In----------f4±�-,a•- ----- Address.. .. .r.- "e--.n_e, =._A•d----------------------------------------------•----...-..-•-•---------------------•----•-----•-•--•---••-............... ' --- Phone_ c.X S._L-?A_-- Contractor's Name--•----------��-t-�--1------..�_1.� 1.1----------------------•------------•---------••--•------........----•----••----• Installation will serve: Residence E3-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ " Number of living units: _1__. Number of bedrooms ...T___ Number of baths _-4n_ Lot size ------/.Y,}--X_f ______________•--_.._..____ Water Supply: Public system ❑ Community system ❑ Private [Depth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0' Hardpan Previous Application Made: (If yes,dote---------- ---------) No @- New Construction: Yes E'No ❑ FHA/VA: Yes 0,- No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well____¢_--___Distance from found ion_____ _ _.._•.-_.Material___ a_1*.C 9'"--_. C --__.. c Ek No. of compartments-----------L----------Size_,Y 7,�? __ ____.___Liquid depth------15lf______________Capacity..-/-Z ` Disposal Field: Distance-from nearest well__g^u_..__Distance from foundation----/..!�----------Distance to nearest lot line.__�F.......... '® Number of lines.............�---------------------Length of each line------ Width of french-----.Z------- -......... .-------- 1 Type of filter material....- ------Depth of filter material....`e_............Total length_______ ______-_--__�I Seepage Pit: Distance to nearest well---fj?_9t_/.......Distance from foundation----f_"?...-------Distance tonearest lot line.... ....... 4t -i 'EA Number of pits____..___.&----------Lining material._.._!� ----Size: Diameter_-__.�J__�-_._____.Depth___.__ _S..................... Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material----------------------------------- ❑ Size: Diameter--------------------•--- ----•-Depth-------------- ------------------------------------Liquid Capacity-------------•-•--------....gals. Aw 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 laws, and rules and regulati�onss of the San Joaquin Local Health District. 5i ned - -- - -----------------------------------------{Owner and/or Contractor) - --------- --- - - ------------------- By:----•-------- -----• --------------------------------------------------------------------------(Title)-.----------•-------------------------- .-....-..-------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). I l FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY_-._-C_..._ �u---5-- ---------------------------------•------------------------------- DATE___ 3:!7_��-------------------------------- REVIEWEDBY----------------- ----•------•------------------ ---------------- - --------------------------I—— -------------------- DATE.-----•-------------------------------------------------..._ BUILDINGPERMIT ISSUED---------------------------------------------------•----•------------- --------- ---------------- DATE--------•----••-------------- Alterations and/or recom end tions:..�"_1�-.1O------.--{_1._...Li4�_ __..._--_ T --,10 w------------------------------- --------------- ------------....._-;------•------------•--........-----------.----•----•--•----------•------••----..:. ...... ---------- --------•------•----•-----------•- --------_--.---•- -------------------------------------•-- -----------------------------------------------..-----•-------...--------••-----------•--.------•-•--------------- FINALINSPECTION BY --------------------------------- Date----QST{ ----- ------------- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 124 Sycamore Stmt 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS