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------- ------ ------------_------ -------- ------------ -f_-. ' APPLICATION FOR SANITATION PERMIT Permit No. 5, = zg....// __ (Complete in Duplicate) ------------------------------------------------------ This Permit Ex fires 1 Year From Date Issued Date `ssuad 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 Ordinco No, 549. JOB ADDRESS AND LOCATION.-�`L-b_--- ---,i- - ------------------ ----------- Owner's Name------- Address ------ ' - �- ? Phone-_..... Address---------- - �II ' , --- - -•-----------------------•------------------- .............................................................. Contractor's Name__.--..___- ---- � -------- °Iii----' ---------•---- Phone Installation will serve: Residence Apartment House [) Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 Number of living units: ___�- Number of bedrooms . Number of baths --- Lot size _-d_• ' /— a Water Supply: Public stem pp : Pb Y' Y ❑r-community system ❑ Private ❑ Depth To Wafter Table �Q-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel .Fi Sa dy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[!t-Ffardpan ❑ Previous Application Made: (If yes,date-----------------_') No New Construction: Yes o ❑ FHANA: Yes ❑ No E�� TYPE OF INSTALLATION AND SPECIFICATIONS: -� (No septic tank or cesspool permitted if public sewer is available within 200 feet f Septic nk: Distance from nearest well�__-_-•-Distance from foundation-/_b. � A No. of compartments __ - Mate+,rial---- P Siz it 45`.0---rye-------Liquid depth---:4 Disposal Field: Distance from nearest well-.-._---_ Capacity._-,F.00 ---_-_Distance from foundation_10-------------Distance to nearest lot hue-. -,•_- Number of lines-_--- _9--- --------------------Leal th of each line----72q.'- Type n Type of filter material,- oG--- q� --•--••----••---Width of trench.---:9--{�_••.--••--_ �. r Qepth of filter material_._&___-_____•----Total length........ -------------- . Q Seepage Pit- Distance to nearest well- _--- ----- Distance from foundation--. o-- _-_ Distance to nearest lot line ---61Number of pits- 1Ct �i ______-- ---------_____ nngmaterial_�-,u _! ___Size: Diameter----3 , Depth-_-oL{ " Cesspool: Distance from nearest wail-----------------Distance from foundation.--__--.------ \1} I. Lining material--. ❑ Size: ❑ Diameter. line --_-----_----D- ept'h--------------- ------------------- ---------------Liquid CapacityacItY•-PrivY: Distance from nearest well---------- - 11------------------- Distance from nearest building --•----•----•-------- Distance to nearest lot • ----gals. - ... Remodeling and/or repairing (describe)--------- ------------------------ ------------- --------- �I •---------------------------------------------------------•-------------•---••--- --------•------- I1 --- II -------•------------------------------------=---------------••-------------------------•------------------------- --------------------------- ----------------------------------------------------------- ---------------------------------------------------------- I hereby certify that I have prepared this application aA that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San'1 g Joaquin Local Health District. (Signed) ----•----•---••----•----------------•-- ' ----- ------ ------------ -------------------------------------------------------- By: ---------------------------------------- ----- (Owner and/or Contractor) BY:•-------•----------•---------------------•----- ------- - - Title --------------------- _ _ _ � ' ---------•--------------------------- (Plot plan, showing size of lot, location em in relation t�wells, buildings, etc., can be placed on reverse side). FOR DEPAW.MENT USE ONLY APPLICATION ACCEPTED BY-------------- --- ---- - -------- ,1 REVIEWED BY �� -----•-A—%---•-- ------------ DATE.---------t 7 . - ---- •----------------------------------------•---- DATE-------•- BUILDING PERMIT ISSUED - --•--...---•---•--•-•----•---•- 1 DATE Alterations and/or recommendations:-_-- --�-4-_-'�p�----��$-'��-i-��- -•;L��----'----... sr •-- ----------------- -------- ----------- --------------------•---------•----------•--------------------------• ------ ------ ---- -----•------------- ------------------- --- ---------- ----------•----------••------------------------- '-------- - -' d-- FINAL INSPECTION BY:...... `--- Date__ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 124 Sycamore Strut 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS