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F R OF4, E; �•x� � ®-do -- 7 --------- APPLICATION FOR SANITATION PERMIT �� Permit No. .-.l ... ....�1..�— (Complete in Duplicate) Date issued __.__ .f__. ___... - -..----------------------------------------------------- I 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. 549. JOB ADDRESS AN ON ----- 0 --------------------------------------•----------------------•---- Owner's Name--------------- ----1------ ---------- -- ----- -Qy/�,/►�d. '�---------- -----------.--- Phone-•----•-------------•- -- Address_.__..___.. -- ---_, YQY _,lla Contractor's Name ------ ------••------•--•-----•-•-----------•----•---•----•--------------•• Phone.... Installation will serve: Residence 9j-'Apartment House ❑ Commercial ❑ Trailer Court I] Motel ❑ Other ❑ Number of living units: __L_ Nu er of bedrooms -- _ Number of baths _j_____ Lot size ...._........................_______________________________ Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table S--/ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: {lf yes,date--------------------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No F4-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material______-__-_____._______•___-•---_--__---_._-----. ❑ No. of compartments--------------------------Size----------------------------•---Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. ❑ Number of lines-----------------------_-----------Length of each line------------------------------Width of french—................................ Type of filter material-------------------------Depth of filter material-----------------------Total length---------fP___-_.____________________- 5eepageP' : Distance to nearest well-------------- pistance from foundation-, ._.__..Distance to nearest lot line._._ J.._ Number of pits----j---------------Lining material--- ------Size: Diameter._. ,, _'j-----Depth__. ,Sr_---___________..._ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------------- ._ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. p, Privy: Distance from nearest well-______-_____________________________ _______Distance from nearest building------------------------------------------ 0 Distance to nearest lot line ------------ ----- Remodeling and/or repairing (describe)--------- -------- -------e .......a�1v-A."G'72.a--•----------------•--------------•-•----•-----••---------••--••---•---•---- -----------------•--•------- ----- •--------•---•--------------------------------•-----•-------------------------------------------------------------------------------------•-•---------------------------- I hereby ce that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat la {�,sand rules regulations of the San Joaquin Local Health District. (Signed)......... •• -d -- ---- J0------ -- - ----- ----------------------------------------------•--------------------------------------- ---(Owner and/or Contractorl By: - - ----------------------------------------------------(Title) G/ ----- _. (Plot plan, showing s' f lot, location 0f system in tion to wells, buildings, etc., can be placed on reverse side). FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED B ,�Y- - -------- -------- ---------------- •---------------•----._.-•----------- DATE----- REVIEWED BY._..._.. - A BUILDING PERMIT ISSUED------------------------ --------------- - -- ----- --- -------------------- Alterations and/or recommendation -- 1 ----------------------------------------------------I-------------------------- --------------------------------------- ...........................................I----------------------------------------------------- ----------- -----•-•-------------•-------•-• ----------------•- ------------ ---------•--- ............................................. FINAL INSPEC SAN JO UIN LOC HEALTH DISTR T 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California ` Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5.62 ATLAS