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FOR OFFICE USE: [�jj CCJj ---------- APPLICATION FOR SANITATION PERMIT Permit No. . t !_..f... ------------------------------------------------------- (Complete in Duplicate) / lti' Z - 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 ith County Ordinance No. 549. Z'Z(Q 1?0—•I JOB ADDRESS AND LOCATION_ .-.-_-_-_SfN ____8FA W_01=_01=__-OA. NDE-P_ -- Owner's Name.. i �M• ? _f_ ----- -------------------------------------- Phone-"---"--------------- iAddress - -- p. ---------s --••------------------------------------------------------• ------•_.. Contractors Name.. 7-� f ��{l # =----------------- Phone.. 4 1 Installation will serve: Residence �Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._.__. Number of bedrooms 3. Number of baths!-- Lot size ....1047 ______r�r��.............. Water Supply: Public system E-. Community system ElPrivate [Depth TO Water Table � ft. Character of soil to a depth of 3 feet: Sand Gravel F] Sandy Loam F1Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------.----------) No 0-_�New Construction' Yes [?'No ❑ FHA/VA: Yes ❑ No TYPE.-OF INSTALLATION AND SPECIFICATIONS. = - . - .1 - .- . - - _ _ -- - -- - - - (No septic tank or cesspool permitted if public sewer is available within 200 1feet:) D 3 Se tic T nk: Distance from nearest well--- �-_..Distance from foundation___ �______________Mat rlaL.�L��:��____. p No. of compartments-------�,�__ _------.--Size__t.X_'7_X__$.---LJquid depth------ ----------------Capacity_.//o--------• Disposal Field: Distance from nearest well---J�._5_0..Distance from foundaticn._ O.......Distance to nearest lot line---- ____.__-_Length of each line.._.._ . Number of lines...._______`.____._ g _ _______.________Width of trench___._______ Type of filter material-_-f�fJC[-\---Depth of filter material_!____Vg_/_�---Total length---------ee�l --------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation_•_................Distance to nearest lot line........... ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth-----------------•----------_---- Cesspool: Distance from nearest well_________________Di.5tance from foundation--�___�__________._.Lining material------------------------------------- ❑ Size: Diameter �pth --------------------Liquid Capacity------....--••------------gals. Privy: Distance from nearest well-_.-__ - ------------------------- -------Distance from nearest building-----------.----------.-------.-------- ... ❑ Distance to nearest lot line_______________________________ `# ------------------- r Remodeling and/or repairing (desc,—I,, ------------------------------------•-- -=---- ---------------------•-------------------------------------------------------- --------------------------------------------------------------- -----R "" -----"•-----4--------------------------------------------------------------------------------- ------------------------------------- ••---------------------------------------------- ------------------------------- ----------------------•---•--------------•--------•-------------------------- ------•----------------- '- •------•------'�-..--------•---------•- 4 r------- --------=------_=-----------_.............--------------------------------------------------------------- ---- hereby certify that'I have prepared this application and.that the work will be done-in accordance with San Joaquin County ordinances, at slaw , and rul an regulations of the Sana'J�oaquin Lrocal Health District{. (Signed).-. . __ 4,�.... •------ -------- ------------ ----------------------------------------------ti-------_-----------.(Owner and/or Contractor) B :•--- ; -------------- Title (Plot plan, showing size of lac, location-of,system ifL relation+o wek,.b. ildings.etc.,,can,be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ tom— --•---- ---------------------------------------•---------------- DATE--------- -7----4-�------- REVIEWEDBY-------------------------------------------------- ----------------- --------------------------------------------------------- DATE------------------------------------------------------------- BUILDING PERMIT ISSUED- =-=----= --- - — ------.- Alterations end/or'rrecommend'aticns:----____ ----� Ei �� -- ----=-----------==---------- ---------•----•-•-•-"---------•-•---"--•-"-----••------...._.-----.,--------- -------------------- ---------- - -- - - ---------- ------------- r ----- -PTH C- Al - ------- 0.1-K ` ` / ---`-�----- FINALINSP ----- Date---- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California M eta,California Tracy,California ES 9 REVISED 5-59 ZM 5-62 ATLAS