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FOR OFFICE SE: I -. APPLICATION FOR SANITATION PERMIT Permit No. �� -��7: ---- ----- J --------- ------------------------- - ----------------------------- (Complete in Duplicate) - -------------------------------- -- - __________________ This Permit Expires 1 Year From Date Issued Date issued ___.____._._.... I ' 7-2cp-off 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 Ordinance No. 549. sus F. 141&SAY y �� JOB ADDRESS AND LOCATION------.-Q_._ -------- w_.L? __-JC' t l� ,�7� p '! 'f Owner's Name----`------. .....�1 r-TQ_ 4`----- --�----------------- -----• ---------------------•--•-- .............. Address--------__................. f � _... . ......•----------------------•-•................................................ Contractor's Nam _ } Ge l. -.7---1---- - --- �... Phone.&!?. 5�1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trai er Court ❑ Motel ❑ Other ❑ Number of living units: ---/-. Number of bedroom__ Number o aths _ ___ Lot size __/�1 p�_. ...,1.. ®..�.____..__ Water Supply: Public system ❑ Community system El Private Depth To Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes ❑ No HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.] pti f Distance from nearest well_________________Distance from foundation--------------------Material-_______-__---____.________---.-------..___.____- No. of compartments--------------- -•- _--_Size---.--.-------------------------Liquid depth-------------------------- Capacity....---••-------- spl— ,field: Distance from nearest well. .__D_-______Distance from foundation__�Q- ___.___.Distance to nearest lot line.... Number of lines___________ ------/---- ----Length of each line. 11 of trench----- f, -f��___._�_____ 4- Type of filter material_ _ ___Depth of filter material..__ _��____.___-Total length______________________��__�_.....__.. Seepage Pit: Distance to nearest we 11________________ ____Distance from foundation....................Distance to nearest lot line------...__.___._ ❑ Number of pits----------••----------Lin' g material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---_----------------Lining material--------.-----------------------._... [� Size: Diameter--------------------------------------Depth--------------------------------------------------._Liquid Capacity------------------ --------gals. Privy: Distance from nearest well________________________-.------------- -------Distance from nearest building-____________.______-----_._______-_-._. ❑ Distance to nearest lot line_------------------------------------------ - --------------- ----------••-•----------------•----•--•---------------•---------------- and/or repairing (describe):________ _ -------- Remodelingr Aj ----------------•-•----....._.........------------------------- ------ ---- •--- - ------ -- ��-------^,- •------------------•------------- ------------------ -------------------------------------------------- -------------------------------------------------------------- --------------------••--------------------------------------------•----•------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws d rul and regulations of the 5 Joaqu' Local Health District. - 1 —v . tic /� ----' ( C 1 (Signed) f `��F ontractor By:.................... -------------------------------- ------- (Til (Plot plan, showing size of lot, location of system in relation to w s, bui t 3, c., can be placed on reverse side]. FOR DEPA TMENT USE ONLY APPLICATION ACCEPTED BY --------------------------- DAT P--- - - ------------------------- REVIEWEDBY--•------------------------------------------ ------ DATE.-- --------------- BUILDINGPERMIT ISSUED---------------------------------------- •------------------------•---------------------------------- DATE.-------....--------••-•------------------------------------- Alterationsand/or recommend'ations:----------------------------------------------------------------------------------------.............................................. -•--•-----------•------- ..........--••- ------------------•---------••---------------------------•-----------------------•---- ------ -------•-•-----------•-•-•--•-------------•---•--------------------------------•-----------. ---•------------- -------------------- --------------------•--------------------•---•---•--- -------- - ------------------------------------------------------- FINAL INSPECTION BY-.-/ .-- - - ----- - --- ---------- 7-- ------ Date.,' ------- ----Z3---------------------------------- SA JOAQU LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California iadl,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS -