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FOR OFFICE USE: ,-� ---------------- - 6 - - - -- APPLICATION FOR SANITATION PERMIT Permit No. ..� ... . (Complete in Duplicate) // Date Issued --- ------------------ This Permit Expires 1 Year From Date Issued .....l. 3.. .Z " 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 withCountyOrdinanct- 6Z,_7 49. JOB ADDRESS A DLO ATION..: v_ O -_ _ �� c—' 0_!1_____________ •. / - . -•-----• ......y� /j'/Owner's Name <•P-------- n.c- �� -----•-•--•-------•.... Phon 7'�,. Address.......................... .. ...... -------------- ... ..- Contractor's Name...0 �.------ \ 1VJC.j.................................. Phon Installation will serve: Residence K Apartment House ❑3 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _t... Number of bedrooms-3___ Number of baths'...(__- Lot size,,_ :,�_^=.,�..�.��. ...._.._.. Water Supply: Public system Community system ❑ Private E] Depth to Water TableA4Ift. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe' Hardpan ❑ Lk Previous Application Made: (If yes,date.------------- No-Q New Construction: Yes ❑ NQ —4HA/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--------------------------•-----Liquid dept-------------------------Capacity.. ...... ,� Dispos Field: Distance from nes est well:____ P%AeDistance from foundation,. ....Distance to nearest lot line.... Number of lines_ -------- _________ ______Length of each lin '� Width of trench._ L��/ Type of filter material. ------__Depth of filter material.__/T-_-___.._.Total length........:.......:. ............... Seeqgee Pit: Distance to nearest well__ 46t-------Distance from foundation_.................Distancp to nearest 19t line:-.:0.......00 p� Number of pits---..................Lining material_.RD _ 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------------------------------------------------------------------------------------•-------------------------------------------- Remodelin and/or repairing describe ______ __ ___ _ _ ____ ___ .------- .._-----•-/ --------------- X11-- - --- --------- --------------------------- I hereby certify that I have prepared this application and that the work will be d no in accordance with San Joaquin County ordinances, State laws,cq/id rules and regulations of the San Joa 'n Local He th strict. ✓✓iitt�a ,fin, (Signed)......f-• c� ---t=fi = --- - ---- ----- ----------------------------- r Contractor) By2z�SEPTIC �E;IVfine A"v K_s�E��41••-------•-------------•--:--- • ... ( le) = -••---------==----•--•--••••-•-----------•-----•-•- (Plot plan, sfiowmg size o�'1ot, location of system in relation t wells, buildings, e , can be placed on reverse side). FOR DEP TMENT USE ONL APPLICATION ACCEPTED BY... --------------------------------------- DATE--3- ............. ---- -------------- --- REVIEWEDBY.................•-•----•-•-------•_.._ . _._.----••------- -------•----------•-••--•-----•--•••---•--. DATE--•--...----------...----------•-------------------•••..... BUILDINGPERMIT ISSUED................................................. ............_...................................... DATE------------------------------------------------------------ Alterations and/or reco�men�a,tions:............... __ 1 -----• ------ . - ------ - -- ------------------ ......A. --•------ v7 ' 2 •'L Q... --- A.....7 r*,.P......e ••••..... FINAL INSPECTION BY:- -- ----- --------------- Date c� .. . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 West Oak Strout 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 8-61 ATLAS