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FOR OFFICE USE: ---------------_----____-_-----____--__-__--__-____-_-- APPLICATION FOR SANITATION PERMIT Permit No. 15..x.1✓` ---------- -------------------------------------- (Complete in Duplicate) Date Issued .__ �11 �-�- --- ------------------ --- , This Permit Expires 1 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 in compliance with County Ordinance No. S49. JOB ADDRESS AND LOCATION..._sS�3I-------Z.......... --��J� I Owner's Name-------/ ..--��,nz eqle-1--------------------------------------•- ------ Phone..'KZf - Address - - --------------------------------------•---------------------------...... Contractor's Name--•--•---- 011Cxoevl ------SNC------------------------------------- Phone.// 9642`)----- Installation will serve: Residence Eff" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l_-_ Number of bedrooms ._ Number of baths .. Lot size -------- -------------------------- Water Supply: Public system ❑ Community system ❑ Private eDepth To Wafter Table 0�Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay Adobe[Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 2'0 New Construction: Yes ❑ No [v?"' FHA/VA: Yes ❑ No Rr TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tpn . Distance from nearest waN-----------------Distance from foundation----------.---------Material_---------------.--..--------------------_------- ❑ No. of compartments--------------------------Size-----------------------------...Liquid depth-------------- -----------Capacity----------------------- Disposal Fi Id, •Distance from-nearest well/ -'.-----Distance from foundation._...5f4---`--.--Distance to nearest lot line.---- [� �&Nu er of lines.............../_------------------Length of each line----------8'O-'........'Width of trench----------. '1'` _--.-_--..- ype of filter material.-./To_sX-.-----_Depth of filter'material.......f--8 -----Total length...............id�A'-------____------ Seepage Pit: Distance to nearest well----------------------Distance from foundation---.................Distance to nearest lot fine................. ❑ Number of pits.---------------------Lining material---------- ------------Size: Diameter---------------------- Depth--..---..-------_.--------------- f Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material_.-.----.-..--.-----------_----._.__. r ❑ Size: Diameter--- ------Depth---- ----------------------- ----------------------Liquid Capacity----------------------------gals. �L— Privy; Distance from;nearest well--------------_----------.------------&_.-_--._Distance from nearest building--------_--_---_-_------------.-..----.-. ❑ Distance to nearest lot line---------------------------------------------------------- ----------------------------------•-•----•---....-----•---------------------- 1 �I � 1 Remodeling and/or repairing (de5cribe):---------fes...... V-- ..... ....... f --------•----------•----------------------••------------ ' 1 --•-•----•---------------------------------------------------------------•---------------------------------•----------------------------------..........-=---------•------- ------------------•-----------•---..------------ i l 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. (Signed) ---•-• -- --------- --------- ---------------------------------------(Owner and/or Contractor) BY= Its=--/ �min --------- - (Title) f -------------------------- (Plot plan, showing size of lot, locationn to wells, buildings, etc., can be placed on reverse side). �.1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------j--a---- - ------------•------------------------ DATE---._1_. j___7 .. ----------------- REVIEWED BY----------------------------------------------- -----------------------------------------------------•------------------••--- DATE------------------------------------------------ ---------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------•---------------•--------- -•------------------------ Alterations and/or recommendrations:------------------ -------------------------- ----------•-- ----..-...--------------------••----••----------------------------••------------------:--------- ---------------------------------------------------------------------'------- ----------•------------ ----------------------------------------------------------- ------------------------------------------------- ------------------------------------•-------i-----------------------------------------------.....---------------------..-..-...........----------.--.-------------. . .---- .------..-•---•-----....... ---------------------------•-------------------------------------------------------------------------------- --------------------------------•----------------------------------------• - -------- ------------1--------- FINAL INSPECTION BY:--------- Ef Date------- ----- .-�------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,Calffornia Tracy,California • E5VISED 8-59 2M 5-62 ATLAS