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f FOR OF FIC EVSE: l ----. APPLICATION FOR SANITATION PERMIT �' r ermit No. .__�/�1._y� ---------------------------------------------------------- (Complete in Duplicate) Date Issued 11) ...------------------.--------------.........____.____-..-_ This Permit,Expires l Year From 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 incompliance with County Ordinance No. 549. ._[cc� }E v� JOB AbDRESS AND LOCATION. rr` f ------L3.......4.-'W1 �' t-� `1----- Owner's Name...... 1. � c.... c�x/�"s ' �'' Phone. " ' _ Address.........3.42. `�---------- ..� r s Contractor's Name •..............: :, -•------------------- Phone-/V..5 . Installation will serve: Resi ence R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j..._ Number of bedrooms .1,_ Number of baths J... Lot size ____1.6-0_ __________________ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 5k Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------)-No [, New Construction: Yes No ❑ FHA/VA: Yes [:] No's TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer'is available within 200 feet.) Septic Tank: Distance from nearest we4/i2A1j_...Distance from foundation__._1.0----------Matyial__ �_4",_- A.rl:�_.-___. 0 p Size__ ._ ... �/ /' r t�iid depth----- ------------------Capaciot- .. . Disposal Field: Distance from nearest well_&jeoe�__Distance from foundation...../-d........Distance to nearest loft ine_....6-_.,.... No. of compartmentsF'' _ ®' Number of Imes------------�-----------------Length of each line--- .7__5------_----__..Width of trench... 3___:--...::.:.:-:_.------_ Type of filter material._._jDe,_K___-----Depth of filter material-----f___8---_...._.Total length-----/..-a`�.4�_�--------------------- ...:--.� Seepage Pit: Distance to nearest well______________________Distance from foundation____-_-F......_._..Distance to nearest lot;line---.-_______----- i ❑ Number.of pits----------------------Lining material-----------------------Size: Diameter------•--••-•------------Depth-------1........................ Cesspool: Distance from nearest well_________________Distance from foundation-------- -----------Lining material..................................... ❑ Size: Diameter-------------------•--1-------------Depth----------------------- ----Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------..___________---..-_-_________- ❑ Distance to nearest lot line--------------------------------------------------------------------- ••--•-----------•------•------------......---•----------------------- Remodelingand/or repairing (describe)-----------------------------------------••----------------•--- -----•-------•......•-•-..__......._....------.._...----._......--..................... ------------••-------------...-------------------------------------------------------------------------------------------------------------------- I ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - .. - - - - ---•----•-------------------------------------•---....-.-------------•--------•------------------------•--------------•-•---------------- 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. (5ignedl. L ------------ ------------------------------------------•--------- .----------[Owner l BY:-----------------------------------------------------------------------------.._..-----------------------------------...-----------(rtle)--------------------...----------------------------------- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----- ' - - -•---------------------•--------- DATE.T,q�' +� -------•------------------- REVIEWED BY--------- ----------------- ------------------------------------------------------------------•-------------------------------- DATE--- ---------------------------•--------....... BUILDING PERMIT ISSUED-------•------------------------------------------: ----_----•-•-#� 1------------- DATE -------------------------------------- Alterations and/or recommen ations•_ " _.__�_..= .-- -�-_�- f•------�--�•• y -----,- � _ _A � FINAL INSPECTION BY:-- ___ `' ' , 'y r SAN JOAQUIN LOCAL HEALTH DISTRICT E 130 South American Street 300 West Oak Srreei 124 Sycamore Street 205 Wart 9th Street ! Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED&-S9 2M 5-61 ATLAS -