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OFFICE USE: ------------------- --------------- PLICATION FOR SANITATION PERMIT Permit No. . - ------ ------------------------------- -----------------• (Complete in Duplicate) oZ - This Permit Expires 1 Year From Date Issued 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 compliance with County Ord in nce No. 549. JOB ADDRESS AND LOCATION�I_._ cr, -- ` -----•---------- f4!e. .« N .. �'t1 - +r c%,jam Owner's Name... ---------••- Address .�_IJL_/1C' / Phone........................----•--•-•- - - ----- - •------ ••-------------------------------•---------------------•------_--------------- • -- --•-------------- Contractor's Name------------_--......................... 2r------- - ---•----_---•---___.__------ Phone----------------------------------- Installation will serve: Residence Ig Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: -------- Number,of bedrooms -------- Number of baths ________ Lot size _____ _ __ _____ _ Water Supply: Public system ❑ Community system ❑ Private 1' Depth To Water Table .--___-_ ft. .Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,8 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date___-_ -------------) No ❑ New Construction: Yes No w , ❑ 19 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permittFdf if public sewer is available within 200. feet.) Septic,Tank: Distance from.nea res+ welC__ __-+_'_.___Distance from foundation___________________Material-___-__ ____._._ VS-frt-, Wo. of compartments ` - Size -------Liquid depth------•-------------------Capacity... .4 Disposal Field: Distance from nearest Well _'Distance from found-ation... �_0 '.....Distance to nearest lot line------ ______ Number of lines--"-------a- ------Length of each fine_.-----6P 1a v_.Width of french---------- Type of filter material_-_-_-- _-.A�Depth offilter•material#-_•---------� `--Total length...................1_6_0...... '� Seepage Pit: Distance to nearest well__;'_________ _______Distance from foundati n--------------------Distance to nearest lot i 3:5 Number of pits__. -��-Lining material-----------------------Size! Diameter -----Depth------------------------------- . Cesspool: y Distance from nearest wel!_________________Distance from foundation------___________--Lining material__-_-___._--_- .2+ ❑ Size: Diameter--------------------------------------Depth-------------- -------- ---- I--------- Liquid Capacity gals. Privy: Distance from nearest well-----__-__*- __________________..__--___Distance from nearest building -----------•-------------- - �r ❑ Distance to nearest lot line---- Remo tiling and/or repairin describ!] '� . ; ` ? ^ w - ; ----- a �- -- --• - T_ _Y ----- --------- = - .. -----------------------•------------------- ••----- - ------------------------------------ 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)- ] �. ' ----• -------------------- - r and/or Contractor) `gy ----- - -- ... -- ---- __ _(Owne d/o C t or iiia) ( of plan, showing size of.lot, Iota on of system'in relation to wells, buildings, etc.;can be plat d on reverse side), - ' Y FOR DEPARTMENT USE ONLY "`� APPLICATION ACCEPTED BY_ _ __--_--_. ---_.-__ DATE_-_-------- REVIEWEDBY....----------------------------------------- -----------------•- --- -------------- ----- DATE---------------•- �. ------------- BUILDING PERMIT ISSUED----••--------------•----------------•--------------------------------------------------••---------- DATE-------------- --- Alterations and/or recommendrations_----- ----------------------•--------••-•-----•--------------- ••--- -- ------ FINAL INSPECTION BY:-- ( sVAN Dete OAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 485 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS E r