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FOR, FFIQE USE: c � APPLICATION FOR SANITATION PERMITPermit No. _,!s^ _ (Complete in Duplicate) --------- ------------------------------ - '� --�- --- 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 Ordina No. S49, _ 4 JOB ADDRESS AND LO ION.__ rz��----- ------- r ] ------- �..._ Owner's Name. ��..- ......... - Phone: :. Address.._ ` n -- ------ - - Contractor's Name. . - = i F r l Phone ... : Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel Other { Number of living,units: ::_ Number of bedrooms _:Number ofbaths':k _ Lot size ......... Water Supply: Public systemCommunity system El401-ft.Private [❑ Depth To Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application;Made: (If yes,date__.----------------1 No ❑ New Construction; Yes No [] � .i❑� ❑ r� FHA/VA: Yes No' � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) ?, { tic 19 i Distance from nearest well_________________Distance from foundation___-=---------Material _____--__-____-_._.___...__.__:...___s..____�_. C No. of compartments-----0--------------------Size------------- ------------------Liquid depth------------- Capacity_ Di -or.sal ie�l Distance,from nearest tl7tQ --Distance froM foundation._ _ ..___.pis#ante to nearest lot line-_____--� r p Numbe'of'lines.----------Ti Length of each line---,,- ---"----Width of french.._ .� �� --- • �''.. Ct G e of filter material. material iYp fiek:.Depth of filter ----- ---- ------Total leAgth --------------Pit: Distance to•nearest well= Ri_(4_______Distanc rom foundation__ ' Q +...V._-..Dis nye to nearest fat line-. ---- P Number of pits.__---t- •�.-Lining_material._ :1 Size: Diameter_q�.)e;]-------•_--.Depth_- ----------•---------' Cesspool: Distance from nearest well--'____-____._,_Distance from oundation--------------------Lining material.--.- '%-"N aterial_________________ 0 •-----------------•- ❑ Size: Diameter--------=---------------��c---------Depth-----------------------• Liquid Capacity gals. 'V1 \ t •---------•--------------; Privy: Distance from nearest well-_--- -_--------------------------------------Distance from nearest building-------------------------------- ❑ Distance to nearest lot line____ _ ' t - ------I------------------------------------------ Remodeling and/or repairing fd1cr6e)______ _ ____ � --- __ --•---------------------••---.---• p -- ___________________________________i_______-______.-.._____.5___.___-- ----__ �-.-----....__ /��4p_j -\W Id _-___ •• ------------------------- -------------- .__._____.•.____..___._ F` t i -'may,_.____ ^_'?.�T II -_ .___._.__�__---• _______________________________________.__._ + ----------••----------•------ --------- ,..Mr,. :, I { i ---------------=-rt-=`= ------ ---- - - ---•- ------------- I hereby certify;that I have prepared this application and�that t e work will'be done to accordance with San Joaquin County b ordinances. St a law , and rules and regulations of t $an Joaqui Lacal Health Dist Ict. z. tl (Signed]_ � -_-�=• '` `�'" - -- Contractor] BY: ----------------------------------- -••-----------(Title)•------------------------------------------------ (Plot plan, showing size of lot, location of system in relation l wells, buildinis etc., can be placed on reverse side). 1 �1 � # FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.___ __. --------------------- ------------------------------ --------- A -REVIEWED _ # DATE �. �3 REVIEWED By -------------- -•------------------------- ---------------------------------------------- DATE BUILDING PERMIT ISSUED---------------------------------- --------------------------------- DATE. Alteration and/ commend 'ons: = - - ------- = .. r- X.,_.. ----d---------- -•-------- ---------•-------------•---------- ------•-----------------....... -- it FINAL INSPECTION BY:.---- ..... 1h Date =U . . SAN JOAQUIN 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 8-59 2M 5-62 ATLAS