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FOR OFFICE USE. I , ------ --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 4... .. ----- ---------- 7 --------------1-- - -0--------------------------- (Complete in Duplicate) Date Issued 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 AND LOCA ION.... `/0 �I/...!_9F-------- Owner's Name------ ... -- ------------ -- -.9_---------------------------------------------------------------- ---------- Phone........_-------------------------- Address............ -------------------------Address....-------•. ------- ----------------------------------------------•--•-•------------------------•------------------------•-••-------------------•-- Contractor's Name r l-� ----------------- --_--------- Phone----------------------------------- Installation will serve: Residence C] Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ______ Nujmber of bedrooms -------- Number of baths __l__._. Lot size __` __ - --.............................. E Water Supply: Public system ❑ Community system ❑ Private [Depth To Wafter Table -_______ ft. Character of soil to a depth of 3 feet I Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E3Adobe Hardpan ❑ + Previous Application Made: (If yes,date_s _________________.) No New Construction: Yes �No ElFHA/VA: Yes ❑ No ®9?"'TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2DD feet.) Septic Tank: Distance from nearest well_s5 ._____Distance from foundation.__&.......... .Material________.______________ _____ No. of compartments------'�.--------------Size-----6- _K__%Y-- ------Liquid depth---_/`�--------------------Capacity._./�O` . _ r � , s Disposal Field: Distance from nearest well_�b__._____Distance from foundation_/O______________Distance to nearest�lojt line_______........... Len th of each line. S,So_!.___�_-------Width of trench_._�`______________________ ®� Number of lines.-_.;___�------------------- g Type of filter material _-_._1�_ _'. .....Depth of filter material_. _f_-_..__Total length__ d_------------------------------ r Seepage Pit: Distance to nearest wellbl� ---------Distance ffjom foundation=:./d------------Distance to nearest lot iinef_�________ _ Number of pits---/-----------------Lining material___'t.L.k..Size: Diameter___33.9'---------Depth----rZ•r................ ... Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------- r ❑ Size: Diameter----,t-------------------------------Depth---------------------------•-----------------------.Liquid Capacity------_----------•-_----gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------•-----------------_--------------- ❑ Distance to nearest lot line------------------- ------------------------------------------------------- -------------------- --------------- ---------•-----•--------------------------------- .�_' . Remodeling and/or repai ing (describe): ---------- ---------------------------- ------------- ---••------------------------------•--•---•------ ---- -----------------•-----•--- ••---•-= ; il I ry--------------------------------- I ______________________________I hereby certify that I have prepared th application and that the work will be done in accordance with San Joaquin County --� ordinances, State laws, and rules end regu ions of he San Joaquin Local Health District. (Signed)____. (Owner and/or Contractor) ay:.. - ----------------------------------------------------------(Title)-------------------------------------- ------------- ----- -- (Plot plan, showing ot, locati)o�t-Qf.system relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ----- —----------------------- ----------- DATE_ �.� / r---- REVIEWEDBY-------------------------------- -------------------------------- --------------------------=------•------------- DA .------------•-----.---------------------------•--------- BUILDINGPERMIT ISSUED----------------------- ----------------------------- Tk--------- a-r-c-------------:-----------------------------�-- 0. _ . : 2= _? r Alterotions and/or recommendations: / --------••-- ..-•--- ------------•-.------.. ----------•-------------------------- ------------------•---------------------------•----------• ----------- - . ------------------•-------------------------------------------- -----------------------------------------------------------.---------•-•---------- .--------------------------------------------------------------------_ I ---•-•----------•--•---------------•-----------------------•---•----------------------------------------------------------------------------- ------ ------...--------------•-•--•--••------------._._...._....------._.... ---------•------------------------- -- - ---------------- --------------------------- ----- • / , t FINAL INSPECTION BY:. --_-- - - '-.-: -`----- ..... --------------------------------- SAN ----------------------SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Strut 124 Sycamore Street 205 West 9th Street k Stockton,California Lodi,California Manrecar California Tracy,California E5 9 REVISED 8-59 ZM 5-62 ATLAS