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✓vR rrlt- ...... �1�• -------✓ --- �.- ,2� APPLICATION FOR SANITATION PERMIT Permit No. ___1.A.61.1�'_ ----------------------- �-------- - �------------- (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 fo!construct and install the work herein described. This application is made in compliance with ounty Ordinance No. 54q. f JOB ADDRESS AN LOCAT ON__.. 44 /_�� r "JJJ t---�------ ......-------- Owner's Name. -----------------�••.. - - /�1tQC r # �h,Phone lr?__:EQ Address__/. _S- _� ---.. Contractor's Name. �� ..__ ----------------------------------------------------------- Phone ~�� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court�jCourt ❑ Motel ❑ Other Number of living units: ........ N ber of bedrooms -------- Number of bath '' V // _______ of SiZe .• __f __ .(Ga_Q_�___ Water Supply: Public system Community system ❑ -Private ❑ Depth to Water Tabley��ft, Character of soil to a depth of 3 feet: Sand [I Gravel L] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8"Aardpan n \ Previous Application Made: {If yes,date........ .........J No Construction: YesNo El FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 03-IV (No septic tank or cesspool permitted if pp4ublic sewer is available within 200 feet.) Septic Ta Distance from nearest-weilC _.Distance frgm foundation_ / ----_---.Material __0..d__ ----------------- No. of compartments-_--_"--`K Size_ —---------------------Liquid de th-----41_1 -- Capacity Q O i Disposal Field- Distance from nearest well722O�-_e__Distance from foundation.-./4..._._.._.Distance to nearest lot line..... ._-�.•_ � Number of lines------ ____________ _______ Len th of each lin r 9 e .a at�; Width of trench_----2.. _. Type of filter material-S'r•__ � ' ---"""_-• epth of filter material----- length--_-----._.-""---"•• `O_-_-- Seepage Pit: Distance to �. neares --ell? __Distance , f fou . ation_ ,l ___Number of pits_ � _.__..Distance to nearest•lot line_._i._. ----•""--._Lining materialSize: Diameter_ ......Depth------ Cesspool: qr, Distance from nearest well-----------------Distance from foundation.......... :___°Lining material..................................... ❑ Size: uid.Capacity.Diameter---------- ----------------------------Depth-------"----------------_-----------------•------- .L'a 9 -----•-•----•----- gals. Privy: Distance from nearest well "-"--"----"_-"- -_ Distance from nearest building---------------------------• Distance to nearest lot line__.___._ . Remodeling and/or repairing (describe):___.--- --------_ r Q1 / --------------- ----- - ��- F*-----•-----------------••- ------------------------------ -------------------------------- ----------------------------------------------------------_----------_•------•_-------•------_-_---------_------•---------__------•---------------- I hereby certify-that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5ta e'iaws nd rules and regul 'ons of the San Joaquin Local Health District. 6t(Signed)- �_ _ ( ner end/or Contractor) s By:.................................... ' -: [Title - -� ------ ` ----" (Plot plan. showing size of lot, location of system in re ation to wells, buildi s, etc.,can be pieced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8YDATE_. /fJ `��7� 1 :. REVIEWED BY. = ------ •---------------------------------- -•- ----- DATE BUILDING PERMIT ISSUED-----_---------------•--------------------------------------- -_------------ - -• DATE"-- Alterations and/or recommendations:__.__ __. _ " J -------------- e J - ----`3� -- ��-" _ --- Z-- - -------- _•-•------•--- -------•----------................--------------------------------------------------------------- ----------------- • -------"-------•------------------------------- .•-------- FINAL INSPECTION BY:..__. -- fig Date----------- -- SAN JOAQUIN 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 J. ES 9 REVISED 8-59 SM 5-61 ATLAS X 1 J