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R OFFICE USE: - '-�r_L.-7---- ------------------------ --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. �a�/,�9 ---------------------•-------- ------ ------------------- (Complete in Duplicate) ---------------- ---------- ----- This Permit Ex fres ] Year From Date Issued 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. /T3 _ 30-12 —30 JO ADDRESS AND-LOCATION.------.if- _.---------�. --------`-�' ,-4----•-- n-J------- RRSC-A--- 9 Owner's Name --_+ Phone. - --------- ------ -- ----------------- ----- - ----- Address.- - - ----------------- ----- ---- -• -. - Contractor's Na -�t.- 9- ---•- - ------ .C2.. ------- J►'� v�'� -1----------------------- Installation will serve: Residence jq Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ . Other ❑ Number of living units: ---L. Number of bedrooms .1__ Number of baths ------- Lot size Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table Z__1T ft.. Character of soil to a depth of 3 feet: Sand 9 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote--__--- _,.--------) No D!� New Construction: Yes PK' No ❑ FHA/VA: Yes ❑ NoA TYPE OF INSTALLATION AND SPECIFICATIONS: ( P p P P * 'r Materiel__. I R No septic tank or cesspool ermined if public server 1s available within 200 feet.) L�.a�.fl_____ _____________ •.,, I? No. of compartments--- -----:---•-------Sizex_�---_----..Liquid depth------1r-`----------- Septic ______---_Ca Se tic Tank: Distance from nearest well___ '�Q__._ _Dist rete from foundation__. y. Disposal Field: Distance from nearest well-----�_a_..._Distance from foundati _-/�_� __.Distance to nearest lot line._._.__..... Number of lines--------v _. __________.___Length of each line. '.Width of trench.--- /�------. I Type of filter material._. Ga�...__Depth of filter material____/p-'!____.__Total length_____-�_•'?0........................ I Seepage Pit: Distance to nearest well------------------------ from foundation....................Distance to nearest lot line________._-...__. ❑ Number of pits----------------------Lining material---- •------- ------.Size: Diameter-----------------.-•---,Depth................. ___..-------__-- i Cesspool: Distance from nearest well-----_-----------Distance from foundation.__-----------------Lining material_-_______..____-__._______-_ ❑ Size: Diameter---------- ----------------='---------Depth------------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest well------:-------------------------------------------Distance from nearest building--------.---_-________ ❑ Distance to nearest lot line---------------------- Remodeling and/or repairing (describe:_-- - :------ ....._--- ------ - -------------------- = = - - --------------------•------------------------•---------------------- s 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) I 12 BY� r im ��-�'�-r tLya -----••--------(Title).._ - ---- -------------- (Plot plan, showing si:el'bf lot, locet' n of sysn relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- = t --. ------------------------------------•------------- _ DATE_=--?--'Z �� REVIEWEDBY-------------------------------------------------- ---------------------------------------------------------------------.--. DATE--- --- •--------------------------------------------------------•- BUILDING PERMIT ISSUED------------------------------------------------------------------•-------------------------•---•--- DATE------ Alterations and/or recommendations:-------------- ----------- -------------------------•-•---------------••--------------••----•--... -•-•------•----------------------- -----------------• -------------------- ---------............. ---------------•------------------•--------••-•----------------•-----------------------------•------------ FINAL INSPECTION BY:----- ----- _-__.___ �7 7 Date.. / -----------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak STree1 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manista,California Tracy,California ES9 REVISEd $•59 2M 5-62 ATLAS