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FOR OFFICE USE: ----------------• --•-------- ---------------- ----•--- ------------------ --- APPLICATION FOR SANITATION PERMIT Permit No. ....:- ____ .5----. "' w ( bbComplete in Duplicate)) Date Issued __. _________________________________________________________ This Permit Expires 1 Year From Date Issued 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 nom liance with County Ordinance No. 549. ESCg1..01,� JOB ADDRESS AND LOCATIONs_�� _.__ _ /? �__.__y✓_G - (fv! 17 - � -------- �'� ---- -/ --- --- -...------- Owner's Name-----------•.... ..:....... .V! u "� ---•---------------•------------------------ - - •--- Phone-.�_"-- -----� J r Address---------------------------1��t---- .z---1 /d X 1� 1I� -------------------- G'........ Contractor's Name..---- .5//�,k/c1A..I.K. Q v ��jl' jp•01--� -----------• ---••-•-------- Phone.. y_7.J_% -- 6 Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number or living units: -------- Number of bedrooms _, ___ Number of baths __/___ Lot size .._._ G---P_ . �---------------------- 0D Water Supply: Public system ❑ Community system ❑ Private [1 J Depth To Water Table ft. p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam II Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: .- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation___________________Material-----------------------._____-.-._______________- ❑ No. of compartments----------------- -------Size------•------------------------Liquid depth--------------------------Capacity-------•---•-----_-- Disposal field: Distance from nearest _____Distance from foundation_..._ZO---------Distance to nearest lot line.... .'..... Number of lines........-------/-----------------Length of each line....... i________._.Width of trench.__,-_------------------------- L Type of filter material._—W!s=��____-Depth of filter material----__-0?_____ Total length...__—_ __________________________ Seepa /it: Distance to nearest well __4___.__Distance from foundation___!D__....___-Distance to nearest lot line2G---_______ Number of pits---------/___.-------Lining material-----j,�c.h'_.--Size: Diameter__.,,S_/-----------Depth•__..._.-1./- ---------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______.____-____________________-____ ❑ Size: Diameter--------------------------------------Depth-------------------------------------- ----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_________________________---_____------.- - -.- ' nce from nearest building------------.--.---_._......._-______.___. ❑ Distance to nearest lot line Remodelingand o ----------------- _---- ----------------------------------------------------------------- � > 4 ----------�4-�.-b--------- NI.P.�1 1 nf'r -.: --- --------------- -13�T {�----------_--Tt ��0 -------•-•----- ••••-- • •---- certify that I have prepared this application and he work will be done in accordance with San Joaquin County ordinances, oaquin Local Health District. (Signed). ��'�'7 Q/P C. J 'e �� /=� � 8�----------------------------------------(Owner and/or Contractor) By:...... .._. .._!!_ G ------------ ------------------------------------•------------------(Title....�O o:c---! 4-/-v----- l- (Plot plan, showing size of lot✓ocation of system in relation to wells, buildings, etc., canbe placed on reverse side). FOR DEPARTMENT USE ONLY Q APPLICATION ACCEPTED BY.---- -1 � ---.i. '0 9 r--------------------------------------------------------------------- DATE------ f�_.6 .......-•---•--------- REVIEWEDBY------------------------------------------------------------------------- ----------------------------------------------- DATE------•--------•--•----------------------................. BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------- -----------•-------- Alteretions and/or recommendations:---------------------------------------------- ------------------------------------------------------------...................-------------------------------- a ------------••---••-------•---•-------------------------------------------------------------------- •----------•-----------------------------------------------------------------------* ------------- ------ -----•---------------------------•---------------------•-•--.---- ---- ------ ---- •---------------------•------------•...... •--•-----................. ..----------------------------------------- .�. FINAL INSPECT N BY -- ----- -_-_- - ----------- Date-------------45__'.!_<..........'75_ — SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS