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FOR QFfICE I,ISE: 7 ' APPLICATION =FOR'-SANITATION PERMIT Permit No. ........... - ------------------------ l (Complete in Duplicate) --------------------- ------------------------------------ This Permit Expires 1 Year From Date Issued 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 Ordinnaannce Nod14 . JOB ADDRESS Q LOC N._ d [!/ - -------•---------•-------- --- "----------- �....�....- Phonelh` �•7 l Owner's Name- -----,-,(�------- ------------ --•---�.¢ �-��-' -- ----•-• Address----------------------------4t_ .. ..... ��gg��---------------------------•--p--------------------•------------...--------•---------•---------------•--.--i-------......•--------------- Contractor's Name------ .. ----------- ------------------- °`" � .°� .G�t.r<.l s �..1�.. T/' _�--------------------- Phone.j�P.-l..3-if . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms .-2,- Number of baths .1----- Lot size __..>�d_ !±> r------------------------•• •••- Water Supply: Public system 2 Community system ❑ Private E] Depth To Water Table 4-6-- ft. Character of soil to a depth of 3 feet: -Sand ❑ Gravel F1Sandy Loam E] Clay Loam ElClay ❑ AdobeHardpan ❑ Previous Application Made: (If yes,date-------- -----) No (J New Construction: Yes eNo ❑ FHA/VA: Yes [7""No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.( Septic ank: Distance from nearest well...`_......Dista o atiquid n................ M I �y _ �_----- de th. ` '`Ca aci d..- © a'lNo. of coriipartrr,ents... Size ' .. p. p tY Disposal Field: Distance from nearest well__- -----Distance from1oundation_. ___......_.Distance to nearest lot li�e_.Lh^._r.._. Number of lines-_--4--------------------------Length of each line----7D--------------------Width of trench-.-.-@"-----------•----•---• I Type of filter maferial.*7.- _&(A—---------Depth of filter material...f 1 ............:.Total length..-.-�®___...........-..._.....___.. Seepage Pit: Distance to nearest well-----'-�.---------Distance_f:.qm foundation-4A.............Distance to nearest lot line_ -........ /._ Number of pits'-__1--------------Lining material_._`-../f115.-�...Size: Diameter-_----j..3..-.-----Depth_-_--- �.......- Q1 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----------------------------------------- F ❑ Distance to nearest lot line------------------------------------------------------------------ -----------------------------•---------------------------------------- Remodeling and/or repairing (describe)--------- -----•---------------••----- --------------••----------...--------•-----------••-------...------------•-••-------------....--•-------•- -------- --•----------------••------•-------------•----------•------ .... -------------------------------------------------------------------------------------------------------------------------------------- 4 - --- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -•------------------------------------ ------------------------------------------------------------ I hereby certify that I have prepared this application an that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of t Sa Joaquin cal Health District. (Signed)... ----/-- / ` �.:�.., L �Contractor) �sy --�-- By*-------------- -4--------- ---. -- )title) (Piot plan, showing ze of lot, location of system in relation to we; s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �] APPLICATION ACCEPTED BY--- ----- - - - ------- -------------------- --------------•------- DATE_... �'` ------�–�---------- REVIEWEDBY------------------------------- --------- --- -------------------------------------------- ------------------------------- DATE--------.....-..-------------------------------------------- i BUILDING PERMIT ISSUED------------_-_- ---------------------------------------- DATE _ ..._. �- _ Alterations and/or rec meadations: -- ---- ----- �..�_Z -s -t�r.-- , -------------------- ----------------....-..-------...----...--....------------------------ --------------------• --------------- --------------- ------------------------------------------------------ ------------------------------------------- ------ Date__ YC FINAL INSPECTION BY.-_x1 ...... ...-.. '_, _==----- - . �. -------------- ---------------------- - ------ --•--••-------...--------•• ..... l SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodl,California Manteca,California Tracy,CallfAmo ES 9 REVISED 8-59 2M S-62 ATLAS s M a