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rUrcVtt, E U E: - �y `--- -- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. .... 141.q_v --------- --------------- -�, {Complete in Duplicate) --- - ---------- This Permit Expires T Year From Date issued Date Issued _._�-�. -�_.I- 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. JOB ADDRESSANDLOCATION__,- 'I- Owner's Na G P. -----------•--- - e_.._` _.._ • -- ------------••- ---- ---------------------------- ------- Phone.---_---------- Address---........ �2 ...__ -•---------•-•---------------•------------------------------ Contractor's Neme-•--•---•-- • --- -----------St ---------------------------------------------------------------------------- c Phone.......................... Installation will serve: Residence @?- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: .._ Number of bedrooms .-3_. Number of baths -srZ Lot size -_- Q-Q!."-1-'? Water Supply: Public system Community system [] Private ❑ Depth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] San y Loam E] Clay Loam E] Clay C] Adobe 6-'-H-ardpan F]Previous Application Made: (if yes,date_. ..... No New Construction: Yes 2rNo ❑ FHA/VA: Yes E Flo TYPE OF INSTALLATION AND SPECIFICATIONS: E] (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /� Septic k: Distance from nearest well_ _-_ Distance from foundatiort/40- ------------Material_�sir-.est"-•- a�C No. of compartments____.__-_.-- - -'-----•••--- -.--size-------*•f-----'RAIZ--------Liquid depth----�'-�-- --------------Capacity %4_o Disposal Field: Distance from nearest well_-- _.__._Distance from foundation./0.�_- ' --_Distance to nearest lot line s- -___----. Number of lines_____________�----------_---.-Length of each line--_-7+5'_______-----------Width of trench.-_afr-h, (l, Type of filter material._--.a G_A------ --- Depth of filter materia ...............� _ 9 '---.______• _Total length See a it: Distance to nearest well----�=------___Qistance from foundation__ ---------Distance to nearest lot line _.^------------ Number of pits"__ -.______Lining material_..-;----_Size: Diameter- ...........De th-_-------------- Cesspool: Distance from nearest well---------------- 0 from foundation.-------------------Lining material------------------------------------- Privy: 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):---------_------------_ 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 ;71at'oris of the fan Joaquin Local Health District. (Signed) -------------- ---------------------(Owner and/or Contractor By: ----- ----- -------- ---------------- -- -- -------------- ----- ---- ---(Title)_. (Plot plan, showing size of lot, location of s tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-._ I _* - ---- -----------------------------------------------•------ DATE-- I REVIEWED BY------------------------------------------ __ BUILDING PERMIT ISSUED---------- ------ Alterations and/or recommendations: FINAL INSPECTION BY---------,.. ---------------------------- Date r Date".... __---- .Z---------------------- SAN JOAQUIN LOCAL, HEALTH DISTRICT 130 South American Street 300 Wort Oak STreet 124 Sycamore Street 205 Wort 9Th Stmt Stockton,California Lodi,California fMlantoco,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS