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FOR OFFICE USE: _____________________-__-------__-.-__.--__--____.____ APPLICATION FOR SANITATION PERMIT Permit No. ._.._._ (Complete in Duplicate) -- z, This Permit Expires 1 Year From Date Issued . Date Issued .. __{P/ Application is hereby made to the San Joaquin Local Health District for a permit to construct ar d install the work herein described. This application is made in compliance with County Ordinance No. 549. , ,f: 00 -ISO z3 JOB ADDRESS AND OCATION `'` dal•••-•.' tl / ------------------------------------' -..------•---_- Owner's Name 1 ----------••-----------------------------------' -------------------------------------------- Phone---------•----------------------•--- Address........-•-•-------' YA....... yam•---------------- -...._-- Contractor's Name- ------••----------•--------------•----•-----------------•-•------------------- ------•------------------------------------- Phone----------------------------------- Installation will serve: Residence 5 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: .!-.... Number of bedrooms -------- Number of baths -�----- Lot size 14-Pb ill.°_____________________________________•. Water Supply: Public system ❑ Community system ❑ Private ® Depth To Water Table P_.. ft. +W Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay I] Adobe❑ Hardpan �] Previous Application Made: (If yes,date--------------------) No fn New Construction: Yes lb No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) E C� Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material------------------------------------------------- El No. of compartments------------ -------------Size----------------------------.--•Liquid depth...-------- ------------•-Capacity----•-•----------•---- Disposal Field: Distance from nearest well_________________Distance from foundation---------------.----Distance to nearest lot line-______---__-...- ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french................................... Type of filter material_____--------------------Depth of filter material----._.....------------Total length------------------------------------------ e e Pit: Distance to nearest well---- b.-----------Distance from foundation--trQ^........Distance to nearest lot iine__ �_________ Number of pifs--'-/----------------Lining material_.(1_!o-�/F ---Size: Diameter__'Yt'itX!-----Depth_--��__-__________...__________ Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material_______-____-_____-_------__-________ ❑ Size: Diameter----------------------- •------------Depth----------------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well----------------------------------_------_-------Distance from nearest building._________.-_-__-___------.._._..-..__-..- ❑ Distance to nearest lot line------------••-----------------------------------------------------------••---------------------•--....__..._ Remodelingand/or repairing (describe):------------------------------------------------------------------------------------.-------------------------------------------------------------------- ---------------------------------------------------------------------------- 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)•------------------- --------------------------------/f --- - -(Owner and/or Contractor) By: -` -•...!f` - (Title)---------- •-----•---------------------------- ----------- - (Plot plan, showin size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). < FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_A41-411 ------------------------------------------------------------- DATE--- �1�1��6'�s------------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE----------------------------------- ••----------- .... BUILDING PERMIT ISSUED-------------------------- ------------ --- --- -- -----------------------•--- DATE------------- Alterations and/or recommendations:---------- — ---------------------------•--•-------------- -••-----•-- --------- ------------------------••-------------•-------------------------•-•-------------------.... -----------------------------•------•-•----------------.-.----•-------•--•------•----•---•----------. -----•----------•- ---•-------------------------------•---------- ---------------------•---------------------------•-------- ---- -----------------------------------•-•--------------_.----.---•---------------------------------------• ------ ------------------------- --........ ---------------- ------------ ----------------------------------•---•------••-------------------------------------------------------------------------------- FINAL INSPECTION BY: rte' -------------------------------- Date-- �..... `�---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS +3e' l