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FOR OFFICE WS� 9 ' ' `------------- ;, APP�L -------------------- _ a. ICAT.-t .._ ..OR• SANITATION PERMIT Permit No. 215Y -------------------- ---------------------- ------------------- ----- --------- (Complete in Duplicate) / tJ`` ---------- - -- This Permit Expires I Year From Date Issued Date Issued ._ _{..._fP. .-. 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 ADDRESS AND LOCATION--3 7� �j��. s A-$ ......----•-----------------------------------------------------------•-•-•....................... Owner's Name - - -------------------------------------------------------------------------------- •----- Phone------------. Address--------------- 2r!'(- ----------• ----------------------------------------------- ----------------------------------------------------------------................................................ Contractor's Name ............Is .z-- ------------------------------------------------------------------•---------- Phone................................... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -----I Number of bedrooms _ Number of baths +;�-__ Lot size .................................... Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table 1.Z it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe�l�ardpan ❑ Previous Application Made: (If yes,date--------------------} No E3 New Construction: Yes o ❑ FHA/VA: Yes ❑ No 99-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic,/Tank: Distance from nearest welly .___Distance from foundation. .l1..............Material.. .'�'"G...... __.. 2 No. of compartments___._!Z---------------Size .._ ------Liquid depth---- _-- --------------Capacity... .. .-.�. ff Disposal Field: Distance from nearest well---!--._.---___Distance from foundation__/-Q__-..-......Distance to nearest lot line..�.......... Number of lines______ _ Length of each line____ E Width of trench.--.3.0..-,..................... Type of filter mate rial__. ______Depth of filter material./$'.4_-_-_______.Total length-Y16110-11_________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line................. Number of pits.---------------------Lining material----------.------------Size: Diameter-----------------------Depth--------------------------------- Q r esspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_-_........_______.____________-___- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well_________________________________________ _______Distance from nearest building------------------------------._._.-___-_. ❑ Distance to nearest lot line-------------------------------- ----------------------------•-•---•-----•-------------------------------------- ------------ ---•----------- Remodeling and/or repairing (describe):-------------•------------------------------ -------- ---------------------------------------------•---•...--•--•------•-•------------•--------------- •---•-•-•------------------------------------------•-------•------------------•----------------------------•---•-------•----------------------------------..----------------------•------------------------------------------- ----•----••---•-------------------------------------•----------•--------•---------------------------------................--------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------I-------------------------------------------------------I-------------------------------------------------------- I --------------- •------------------••-------------------------------....----------------....----------------------------•--------------------------- I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regul ' ns o the San Joaquin Local Health District. (Signed)-------------------------------------------------------- ------- ------------ ------------------------------------ ------------------------------------------(Owner and/or Contractor) By; (Title) - ------------- (Plot plan, showing size of loft, oca n stem in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----C----- ---------------------------------------------- •- • •-------. DATE--i-- --a ------------------------------- REVIEWEDBY----------------------------------------•--- --------------------------------------------------------------------•-•----- DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED...........................----------------------------------------------------------•-•-------•---- DATE------------------------------- �-------------------------- Alterations and/or recommend'a+ions--------------------------------------------------------------------------------------------------.----------------------------------...................--------- ...................•-•-----•---------••------------•--• ----------------------------------------------------------------.......-------------------------------------------------------------------------------------------- ----------------- -------------------------------------------- ----------------c-------- --------•---------------•-------------------•-------------------•--•---------------•-------------------------------------------------------------------- FINAL INSPECTION BY:---L.k... G —------------------------ Date-t- g ---(-S------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 305 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 zM 5-42 ATLAS 1