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FOR F�C- U5� : y �f ----. APPLICATIQN FOR SANITATION PERMIT Permit No .. •_-:_69-:7, . _ �~ (Complete in Duplicate) / -------- ------ --------- '+--- This Permit Expires 1 Year From Date Issued Date Issued ---?/;?v 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 Ordinan�eNo,. 4A9. JOB ADDRESS D LOCATION..... C ----------------- •-------------....... Owner's Name- Address-------------------•- --- ------------ Contractor's Name__- ._..__... -- .. 77 Z-,-77 /-r___1-10 -•--•----------------- Phon f . ._...V --. Installation will serve: Residence Apartment House . Commercial .❑ Trailer Court Mote! Other Number of living units: mber of bedrooms o�?__ _ --_- Number of baths -- -_--_ Lot size -a5"? _:.__---- -__••-•-_--___• Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table 1�- -ft. Character,of soil to a depth of 3 feet: Sand ❑ Previous Application Made: {If yes,dclte--------------------Gravel ❑ Sandy Loom E] Clay Loam [jClay ❑ dobe Hardpan ❑ ) No ❑- New Construction: Yes ❑ No Er FHA/VA: Yes ❑ No ❑ TYPE OF,INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S is Distance from nearest well-----------------Distance from foundation--------.-----------Material,--------_-.----_-._--...----..__..----..._-.__.. No. of compartments------------------------- Size--------------------------------Li Liquid de th_-__----___._-- - Capacity q P -- ----•---•-'---•-.--� I Dr;<o sal e Distance from neare�t well__[ Distance from foundation.... 1 ......Distance to nearest lot line...... ....... Number of lines__-..- _"140- Length of each line------ -.Width of trenchs �f _-- Depth of filter material_.. .�{�- � Type of filter materia �'--_.----Total length______________r_�.. 'Q_- Seepage Pit: Distance to neare t wDistance from foundation'.-;--`e--'---Distance to nearest lot line.ew-! Number of pits----I----------------Lining material` ---_-..Size: Diameter__: Depth----- I. —Ij-- ----------- Cesspool: Distance from nearest well-----------------Distance from foundation.__-- _-__.Li i g material_.-.___.----_--__._._.--.---__....- ❑ Size: Diameter-------------'-------- ---------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building Distance to nearest lot line q, Remodeling and/or repairing (descr• e)-------------- --------- ------- -------------------•------•---------------- -- ------ --------- ------------- ------------------•------ ----------- -------- �---•------------•---...-----------•-------•------------------ -----------•------------- ------------------------------ ...------ •------=-----•-------•--•------------------••- ------------------•----•----•------ -------•-------------------•-------- ----- ---- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta I , a rul and r gulations of the San Joaqui cal Health District. [Signed )-� ��. � f Contractor) By:... ---- ----------------(Title)------------------------------------- ----- ---------- ' (Plot plan, showing size of lot, location of system in rel I to wells, buildi s, a c., can be placed on reverse side), FOR DEPARTMENT USE ONLY Aj 4' APPLICATION ACCEPTED BY------..- • DATE --•------- REVIEWEDBY------------------------ -------------------- •-•-----------------• DATE..-•- ti BUILDING PERMIT ISSUED------------------------------ ----------------------;----•----------------•----------- -----• DATE.------ - Alterations nd/or recommendations:------ -j- ; mac �- � _��: -- -------------------- r. ---------------------------- - FINAL INSPECTION BY:.... .......C:r!� � E=_S ---------•. Date----------- --------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 21A 5-62 ATLAS �, _ Y"•`^�+