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FOR OFFICE USE: s "3-------------- � ______________________________________._____..---.___. APPLICATION F R SANITATION PERMIT Permit No. . ---- --------------------------------------------------------- (Complete in Duplicate) E,--� 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION --'7--•Erb------�--------------- --------- .. " Owner's Name .- r.- - ----------------------•- Phone . �� 9y Address.. / 1`-------- ---- ---- .--•-• . ..........--•---......---•--••------••----...._... Confiractor's Name.. 0---------• -------------- --• Phone.....................-............. Installation will serve: Residence ❑ Apartment House [] Commercial ❑ Trailer Court ❑ 1 Motel ❑ Other ® C�- Number of living units: __vNumber of bedrooms ____Number of baths __ Lot size .............. /____,t"__----_-__-__f_-__-- Water Supply: Public system 0 Community system ❑ Private ❑ Depth To Water Tabled-r. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [2r Clay ❑ Adobe❑ Hardpan ❑ a Previous Application Made: (If yes,date--- ----------------) No [A New Construction: Yes ❑ No R 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--------------------------------Liuid depth--_----------- ---------Caaci Disposal Meld: j ,Distance from nearest well-- — ___Distance from foundation.___, _a_...._.Distance to nearest lot line.....4 .... !`TiF '_ ® ./�1umber of lines______________ _ ----------------Length,of-each-line- �Q-----Width of french--------------Z;1-•>---•-•---- Type of filter material -_-Depth of filter material---_-_, length-.,,... }� Seepage Pit: Distance to nearest well------------- _____Distance frw foundation ....LS`.i2t_Distance to nearest lot Number of pits______-./------------Lining material____ r. Size,:-.Diameter..__--3— __-.Depth-----------Z_,1-._'--------- Cesspool: Distance from nearest well-------- from foundation...______________Lining material..................................... P R Size: Diameter------------------------------ ---- -De th-------------------------------- -----------.-Liquid Capacity............................gals. Privy: Distance from nearest well-_____________ ------ _i________--------- _______Distance from nearest building-----------------------_----------------- . ❑ Distance to nearest lot line---------------------••----•----------------------------------------•-----•---------------------•--- Remodelin and/or repairing ____-_.___-5�. I- ---------------- . . � -�' � ---•------------------------ --------- -- �•------------------- -••------------------------------- ----- - ---••----•- ------- -- ---.....-----------------------------------------------•--------•---------- S _________________________________ --------- --_________._____--..-..__....______.____________.._____----_______--_--____-_--__-_-__-_____________-_-__-__._.__-- hereby certify"that I have prepared +itis application and fha+ 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)----------------------------------------------- ------ -----------------------------------------------------------(Owner and/or Contractor) �-- - -- rifle --- -------------- (Plot plan, showing size of lot, to Pion o ys+em in relation to wells, buildings, etc., can be placed on reverse side). R DEP TMENT USE ONLY APPLICATION ACCEPTED BY--- ---- T DATE --- � Z - =------------- REVIEWEDBY_---------------------- ----------._w--------------------------------------------- ------- DATE------•-------- BUILDINGPERMIT ISSUED---------------------------------------------------•------------------------------------------------ DATE........--•---•--••----------------------------------------- Alter fieri nd/or recommendafions: �� ------.--------- ��------------------------•--••----- y / ------------------------------•-•-•----------------•-------•-•---•------------------------- / _____________//____.._-__-_._-__.___._..!__/_._...-__.__.____._.__.__.--____--...-_---_-..______..__._____________!_/._.___-.-___-___________.__._______--__-__-.--.-.._--.-_-____._-....-._.___....___.____._____--.___-_____-___ ................._-----------------________.............._----------------___-------------------------------------------------------------------_---_____--------_------------------------------------------------------------ FINAL INSPECTION BY:.----.... :? -----. � bate SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak-street 124 sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS