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FOR OFFICE SE: - ; 1a, ` �d? � 7--- ------------ - - . -------- --------- ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ... �'� �_9 ----------------------------------- ------------------- (Complete in Duplicate) y X __..- -- This Permit Expires ] Year From Date Issued Date Issued ---------- i 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 ' compliance with County Ordinance No. 549. 11 JOB ADDRESS AND LOCATION__l�__.0_.c_.-. 7 _ m-A-_ J 7 Owner's Name -•----•--- •------------------ Address =- y-..__ _ Contractor's Name_tJ--h.�..---�-•-A ---------------------------•------------- Phone._j_15e1.1_....L.12.1..1 t t 1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel [3 Other _O _csa__- j Number of living units: __�___ er of bedrooms =r Number of baths --/-_ Lot size Water Supply: Public system Community system ❑ Priv e ❑ Depth To Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob Hardpan ❑ Previous Application Made: ilf yes,date--------------------) No ❑ New Construction: Yes ❑ No�A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet:) T Septic Tank- Distance from nearest well _ _6_PL-_-Q-_Distance from foundation foundation_-_ . ----- a --_c ___________ Q �--•--_-•_- -. a ciNo. of compartments___.. . _____,--..._Size. _� _.Li uid de h---- _-- Disposal _ ' F• d: Disfance from nearestell-jRrxs.a1.-_Distanee from-Toundation--_�. .'.._ Distance to nearest lot ___----Q.....�' Number of lines_________ Length of each line------------ *f-� Width of trench-_. ..___________ Type of.filter material_.. ._ _ _� J�'Do th of filter material--------- '"�.-,Total length-__._.. ______________ /i ! �` t Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------..Distance to nearest lot line...----__--._-.-_ ❑ Number-of pits_:"---------------Lining material-----------------------Size: Diameter------------------------Depth-.---------------..-------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material__..-._----_-----___---------- ❑ Size: Diameter--------------------------------------Depth_-------------------------------------------------Liquid Capacity---------------------------gals? �,ti; Privy: Distance from nearest well-------------------5_____.--------------- ------Distance from nearest building------------------------------------------ ! ❑ Distance to nearest lot line_--_______---.----_- F {'h --------------- ------------•-•----------------------------- ----•------------------- l Remodeling and/or repairing (describe)------------------ - --- } - - ++ - 1- 1t.- f ----------•--•----•----•------•---•--------------------------- ------------ -- --------- ---s ------- -------------- •----------- ----------_------- I hereby 'fy that I have prepared this application and that the ?�&(& will be done in accordance with San Joaquin County ordinances, a aw and rules an regulations he a ocal alth District. � (Signed) - VC-`----------------------------------�dr Contractor) By:. ------- ---------- -- -- - -- - --- -----------(rifle) -- (Plot plan, showing size of lot, location of system in rely to wells, buildi s, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY S APPLICATION ACCEPTED BY ' ------ DATE--------1.;..^......7-6 REVIEWEDBY-------------------------------- ••-----=----------------------------------------------- =----------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------•----•----------------------------------• DATE----------------------------------- Alterations and/or recommendations:---- --------------------------------------------------------------------.-.--------------------•------•----.._------------.... �7 ..................... .........................................-------------------------------••----------------------------------------------------•-------•----------------------------------------------------------------- ----------------------••---...___----------.....-.-..--...._-----------...._._.._ !. FINAL INSPECTION BY:............... Date----� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stocktonr California Lodi,California Manteca,California Tracy,California ES 4 REVISED B-59 2M 5-62 ATLAS t