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FOR OFFICE USE: APPLICATION-—FOR SANITATION PERMIT Permit No. .../-_ ----------------------------------------------------- _ --------------------------------- ------------------- (Complete in Duplicate} 3 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,/rf�✓._12-_____ Owner's Name----•-_4W11.61-I-- ------ ---- •-• ------------•------ Phone......................... Address------••-•-----11'.d.`.....J� Its• -----------•------------ r.'- -------------------................................................................................. Contractor's Name - -------- ---•----------------------------•------------------••-------••-•••--------- ...--------------------- Phone................................. Installation will serve: Residence k3 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ aOther ❑ p Number of living units: __I____ Number of bedrooms .- --- Number of baths I___ Lot size 3 Water Supply: Public system J� Community system ❑ Private ❑ Depth to Wafter Table 4.0.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 4 Clay Loam JR3 Clair ❑ Adobe❑ Hardpan ❑ Previous Application Made: {lf yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,c Septic Tank: Distance from nearest we11.40"i"...Dista �efrom foundation---le----------.Material--- ------•••=•-•-••••_---•• �] No. of compartments.._.-----------------Sized I•-- 't---5--------Liquid depth__-_____-Y--------------Capacity. 2'?...... 1 Disposal Field: Distance from nearest wellrP-- -____Distance from foundation_ b_____________Distance to nearest lot line.::-......... (x Number of lines____________ ________Length of each line-----td'________________Width of trench._._.._.`.------------------ ____ Type of filter materia fc p �- g __ _De Depth of filter material---- length .._..---_----_----.._... 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_________________Distance from foundation-------------------Lining material.......................... ❑ Size: Diameter------------------------•-------------Depth----------------------------------------------------Liquid Capacity----_......................gals. Privy: Distance from nearest-well----------------- ______Distance from nearest building.....................___________________- 1. ❑ Distance to nearest lot line.----------------------------------------------- ---------•----•-•-------•------------------------------------------------__-------------- N Remodeling and/or repairing (describe)------------------ ----•--------------•------•-••-------------------------------•----•-----••---•--------•--•-------------------•--------•••-•-•- -------------------•----•---------•-•--•-•-- -----••-------•-•------••----•---------------------------- -•-----•----•---------------------------------•---------•------------____----------------------------------•----- 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 r gulations of the San Joaquin Local Health District. (Signed)--/�';�' I--_------& 1------- ��-----------------------------------•-------------------------___---(Owner and/or Contractor) By:............------------------------ -----------------------_-------------------_---_----.-----------------_----_.__--_----(Title)---------------------------------------------- .............. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY + APPLICATION ACCEPTED BYI �_ �-ft-U _-4------------------------------------------------------------ DATE-.4 7-- �74,_2--=-------------------------------- � REVIEWEDBY------ --------•--------------------------------------------------------------- ---------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------__--------------- _--------------------- DATE------------------------- ----------------------------------- Alterations and/or recommendations:--.-------- ---------------------------------------------------------•------•-•------------------------------------------------------------------------------- _---•-----•------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------- -- - -- --- - -------- ........... ..............-------- - ------------------------------------•------------------------ --- ---•------------- ---------------- •- FINAL INSPECTION BY: ---- ---- -- ------------------------ Date. ` 6 •---- --•------ ------ ----------------------------- i� SAN JOAQUIN LOCAL HEALTH DISTRICT 1R 130 South American Street 300 West Oak Strout 124 Sycamore Street 205 West 91h Street s. Slotkton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 6-61 ATLAS _ 1�