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FOR OFFICE USE. �l levAN' ---- ------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ... .5r3! l --------------------------------- ----------------------- Complete in Duplicate) _ ( 3 This Permit Expires 1-Year From Date Issued Date Issued _________________ Application is hereby made to the San Joaquin Local Health District for a . , peit t nstr�uct a d in llth)�wk herein descrbed. t �This applicationis made in.compliance with,County Ordinance No. 549. Z JOB ADDRESS AND L.00ATIONr_ r 0+-.f1_,0->.( -J_p Owner's Name '�� w�-U Phone�CG...... ..�. d -- -----------------�--------`d--�------ Address._.-----•-I-�- ( Qr- ---•--•--------•-•-- �� t'c. - Can#ractor s •Name. a...-------•------� "' ---------- _---------------------- InstallationyPilose ... .. i b will serve: Residence [Apartment House ❑Commercial ❑ Trailer Court ❑ aMotel ❑ Other ❑ Number of living units: ----L Number of bedrooms -------- Number of baths ----I--- Lot size ..._ ................... Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table �Pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--.-----------------I No New Construction: Yes B'-'No ❑ FHA/VA: Yes ❑ No OR-" _ TYPE OF INSTALLATION,AND'SPECIFICATIONS: (No septic tank or cesspool.permitted if public sewer is available within 200 feet.) rr�5,eptic T� Distance,from nearest well_________________Distance from foundation____.__________.._..Material__._.___._____._....__________.......--------_-. `, J No. of compartments--------------------------Size--------------------------------Liquid depth---------------- --•------Capacity------------------•---- Disposal Fiel } Distance:from nearest.well_--------------Distance from foundation--------------------Distance to nearest lot line................. Number of lines---- ---------- Length of each line------------------------------Width of trench------------- --- _ - ...._._. ...___.f_..__._.YPe o filter material---------------------__Depth of filter material---------------I-------Total length......... --- -•---...-•---�SeeP 9e Pit: Distance.to nearest well .-j-O ,-__---Distance from foundation... is...........Distance.to,,nearest lot line_--- Number of pits-------I-----`----_3_Lining material... -----Size: Diameter---�l'// f Depth__ 7�7C-___-- Cesspool: Distance':from nearest well--------------_-Distance from foundation----------.---------Lining material------------------------------------- El Size: Diameter.--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance-from nearest well--------------------------------------------------Distance from nearest building----------------------------.__......_---. ❑ Distance;to nearest loft line------------------•----------------------------------------•--------- Remodeling and/or repairing (describe):__.._"_ �.----____ l .lr_s-_ ___��_ ��.�tJ %J ._. ..... -------•---------------- ----------------••------------------•-•---------------•------------•--•-.-----------•---••---•---------------------- -------------------------• -----------------------------------•-•------------------ --••--------------------•------------------•----•----....--------------••----------•-- ------------------------ ------------ -•-----------------••---------------------------•--------•-----------------------•-----------------•-------------------•---------------•-------------•-----•---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 (Signed.) { -- = Qm �- ----•---. ----- __ -- -- --- -------- _2 ----- Octor} ( wner end or Con+ra _ Y�---- ----- �----.-. — ----------------------- ---------------------------------------------(Title)------� J_ (Plot plan, showing size df lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f w-P FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --------------------- --- --••--------------•-•--- DATE...._-.-_ i. _'.s 3... REVIEWEDBY. ----------------- -----------------------------------------------------------------------------•---- DATE------------------- BUILDINGPERMIT ISSUED__!--------------- -----------------------------------------------------------------------------..... DATE---------------------------------------------- Alterations and/or recommendations:...--------------------------------------------•-..---------------... ---•-••---------- ----------- --------- ------------------••---•---•------------- ----------••--•--------------•------------------------------------------------------------------------------------------------------------ ---------- f FINAL INSPECTION ... Date /./... _.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS i 1