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7r �. FOR OFFICE USE: t 0 - 7ls%u� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicatel g • 4 --.--- This Permit Expires 1 Year From Date Issued Date Issued .................... 1 Application is hereby-made to the San Joaquin Local Health District for a permit to construct and install the�w rk herein described. This applicati& is made in compliance with County Ordinance No. 549. �� JOB ADDRESS AND LOCATION.. _. .. -_-----------------aa __ ---------------- .-, _.-a-4 r Owner's Phone.Y ----.%, _Op --- Address---------------`� " f }� --------- ---------................................••.............. Contractor's .Name. . `� '� � lsrc-.�u -`---------------•--•-----------------------•--- ......---• Phone. ----� 4rilZ---- r Installation will serve: Reatdenee [Apartment House ❑ Commercial ❑ Trailer Court ❑:' :Motel ❑ Other J� Number of living units: 2�— Number of bedrooms- ___ Number of baths __I-_- Lot;size . t J________________________________ Water Supply: Public system ❑ Community system p Private Depth To Water Table .-O_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No [�t FHA/VA: Yes ❑ No ER Q TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if publ'c sewer is available within'200 feet.) Septic Tank: Distance from nearest well__ O---• Dis# n (torp-fours c7tion____ ___.._..Mat tial.-C�r .___.I / /r [ No. of compartments___#�----------------Sj� -f -- ---. . Liquid depth__....- ---------------Capacity....1}�ByDispos I Field: Distance from nearest well__-�-�-Distance from foundation. ._._.Distance to nearest lot line-_-.Number of lines___.: Length of each line..�__�________________Width of trench__-_�j!__.-......___ �Type of filter material - _:..__Depth of filter material______ !__--__Total length___-____/_1,0----_____________Seepage Pit: Distance to nearest well-..___-____ jDistance from foundation....................Distance to nearest lot line-----_________Number of pits----------------------Lining material----------------------Size: Diameter----.---.--------------Depth----•-----------------••-----Cesspool: Distance from nearest well_____________ _Disttance from foundation--__-- ________.Lining material_____________-__----______________ p Size: Diameter--------------------------------------De th--------------- ------------------------------------Liquid Capacity------------------------_--gals. Privy: Distance from nearest well-------------------------------------------------- from nearest building.____.__.___-__-_________________--____._ ❑ Distance to nearest lot line-----------------------------------------------------------------------........ •------------------------••-----•---------------------------- J Ra Dilating and/or repairing (describe):-- , -- -.--• •.... . -•-••.----- ... ------- •-- -------------------•------------ --------- -- -•-------- ---- er y certify that I have prepared this application an at the c well bone in accordance with San Joaquin County „ ordi Trces,, fafe laws, and rules and regulations of the San oaquin Local Health District. fir (Sinail c� ; g ) `�' �Q s t r1- ._,. -- --- ( a>��ar Contractor) By;--------------------------------------------------------------- - ------ = ------------(Title)-------------------------------- ------ ----- - -- --------- (Piot plan, showing size of lot;'location of system in relation wells, buildin s, etc., can be placed on reverse side). F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY________ _____ "tel e ��-��--•-------------------------•-•---------------- DATE.------�--�--- ---x----S•--- -..,C��'-------------• REVIEWED BY------------------------------- --------�------------ --------------------------------------------------------------- DATE----------- ------•---- ---------- --------------------- �# BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------- - ---------------------•---------- Alterations and/or recommendations------------------- -----------------------------------•--••----------------------------------------------------------------------------------------------- ----------------------- -------------------------------------------- ------------------------------------------------------•--••-----------------------•-----------------•---------•-• ------------------------ ---------------------------------------------T------------------- ------- ------------------•-------------...-------------:----•---------------.............._..-----------------------------------•---•---•------- -------•-• ------------------------- -- ------•--- =--•------ ----•-- ------------------------------ --------------•--------•--•------------------------------------------------------------------------------------ .�. �� s/ FINAL INSPECTION BY:--------------------- ---- --- ---�-- .rc.�-�� Date------- -- ---- ...- --�---- - ---------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS P.