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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _---_--_-- -- -.. - --------- ---•--- --- ------------ ------------- (Complete in Duplicate) // 5 --- ----- ------------------- This permit Expires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and iriftall the work here' described. This application is made intom 'ante with County Ordinance No. 549. �Z 070-0 �z8- F_- .j,C-6 - f JOB ADDRESS AND LOCATION. DF l�)_L---------- RJP.. �_-_-V1�---D-r------V1V[-(7ry------------------- ------------------------ Owner's Name ti �'=f � - .. ` �--------- - Phone.. -3=z7l-�------ Address-----•-_RT-R--`1 �QK----- J 14 1T CI`�----------------••-•------ - Controctor's Name. it .. .. r --------------••--------._--.------------------------y: 44_ Phone Installation will serve: Residence [� Apartment House 0 Commercial ❑ Trailer Court-C] Motel ❑ Other 0 Number of living units: ___/___ Number of bedrooms 3-- Number of baths Lot size __ lx _________________________ Water Supply: Public system ❑ Community s stem [��Pri ate Depth ro Water Table 7tZ'� Character of soil to a depth of 3 feet: Sand Gravel❑ endy Loam ❑Cley Loam❑ Clay CE, Globe❑ Hardpan ❑ Previous Application Made: (If yes,date------------- `._} No W New Construction: Yes R;,-No [3FHA/VA: Yes ❑ Noe � r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s Septic Tank: Distance from nearest well__ ------Distance from foundation--------------------Materi I..... 1 ____l� No, of comp6rtments__._____'�.9t____Size3_X_`j.___X__�------Liquid depth""- -- _1-----Capacity...-9.00..... Disposal Field: Distance from nearest well__-_ -.-Distance from foundation....1.Q,!.....Distanc. to nearest lot line_..��.. Tr Nurnber of lines__..__/__________________.______Length of each line___.____�/,0-_______"� .Width of trench__-------- ��__________-•"11% °gyp of filter material-___ K__Depth of filter material..--.---- _47-------Total length____._ `_________________________ Seepage Pit: Distance to nearest.,aw,ellh., 4t. -,...b.Distance-from^foundation._./ -..Distance to nearest lot line-___�. Number of pits_______ ____________Lining m1�, aterial_.RQ_C_ __..Size: Diameter_�_,X..3`�.,Depth--- � .-.:................ .. Cesspool: Distance from nearest well_________________Distance from foundation_-------------------Lining material_.-.-------------.------------ ....- ❑ Size: Diameter--------k-----------------------------Depth------------r ------- -------Liquid Capacity----------------------------gal Privy: Distance from nearest well-------------------------- ----------- -------Distance from nearest building--------------------•--------------------- ❑ Distance to nearestlot line--------------------- ; t"�"'} � � I ' --------------•---------------- Remodeling and/or repairing (describet-------------------------------------- --------------•------------------------•---------------------- I---------------------•----------•---------------- i ^ i 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)--------- ---.-.-----5z��'✓eC._P------_-_•--------•-•-----------------{Owner an Contractor) a • .... ....................... Title-------------------- --------------------- -I.. (Plot plan, showing size lot, location of system in r4lallon to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMI_NT USE ONLY APPLICATION ACCEPTED BY--------- ------------------------- k------------------------------------ DATE-------- �--------------- REViEWED BY.-..- ----------------------------------- DATE - ---------- BUILDING PERMIT ISSUED_-----•--------------------------- ---------------.a,..-..___ = DATE-------•- • ----•---------------------------------------- Alterations ------- -Alterations and/or recommendrations_---------------------- -_ -•--•--•-----------------------•--------------------•----•-----•------------------------------------- ---------------------------------------------------------------------------------------•--•--•---••-------------------•- -------•-•--••----•-------•-•----•----------------•----•-•. ----- --- -----------------------------------------------------------------------------------------------••----.._..---------------------------------.•---.- -•-•---------•---------------------- -------------- ---•-- ---- - ------------------•----• - -- ------------------------------------------•-•-----------------------------------------------------•----•-------------- FINAL INSPECTION Date_.._--!_�-- .... ----------- JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californla Lodi,California Manteca,California Tracy,California E5 9 REVISED a-59 2M 5-62 ATLAS 1