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FOR OFFICE USE: ----------------------- ---- - � --------------------------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._. .... --------- -------------------------------- --------- 9 (Complete in Duplicate) -- - f ---------- -- This Permit Expires 1 Year From Date Issued Date Issued .__ .__1 --- rt rApplication is hereby made to the Sen 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________ _ __ Owner's Name........ W �E` . _J� 7i �r - _.__.._- . Address....................... /` . .9.t ._- " ' E r•�-------------•---------------- ...... Contractor's Name...... , t c /6- CO.d!C �e_i In ... -__—>147 Q. .... Phone_ ... .. 7-..,17 �. �--- -- --. _.... �t,/........ ..........•--•- Installation will serve: Residence ® Apartment House ❑ ,Commercial Trailer Court JJ _ ❑ ❑ Mote! ❑ Other ❑ Wafer Number of living units: J---- Number of bedrooms _ - Number of baths ./---- Lot size ..._.. - r Supply: Public system ❑ Community system ❑ Private 0 Depth To Water Tablelc__e. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan t Previous Application Made: (If yes,date--------------------) No New Construcrion: Yes ❑ No 2r�_'FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t " 'Septic Tank: Distance from nearest well_'=___--_`:"`...Distanc_--e f-rn-foutidation__._ =___ :".Mater4l. No. of compartm'nts----------------------7-_Size__ -------------------------•---Liquid depth------. ------Capacity Disposal Field: Distance from nearest welL_-,,-TrJ------Distance from foundation-----hl -----Distance to nearest lot line-_-/0, r❑'— Number of lines-------------------------------Length of each line--------- -----------Width of trench-----�------•------------- Type of filter material...-_4.4'l -------Depth of filter material....L ............Total length........lei=d.__ ._______-•_•__ Seepage Pit: Distance to nearest well----1Cl_4--------Distance from foundation_...Z4_....__.Distance to nearest lot line__./d-_f-•- ❑ Number of pits---------!�----------Lining material-------2301�-Size: Diamete r-___&7eT 67_.Depth'__.//_�_.__--_--_-----•• Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining ❑ Size: Diameter--------------------------------------Depth-------- --- Liquid Capacity.. gals. Privy: � Distance from nearest well___ -_- __--.-_-_Distance from nearest building ------------------------------------•----------------------------------------- I --------Distance to nearest lot line. ---------------------------------------------------------------------------------- ------•--------••------•-------••-•-----•---------- Remodeling and/or repairing fdescribe): _ ------ - ------------ I - = ---'-- ----- a -�---�� i r J U • '�rw' -----------------------— 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 regulations of the San Joaquin Local Health District. ;.(Signed)-----•---C� ---- Q= =C' c== / �'= + i ��- -��--------.:--..___:_______-(Owner andfor'Contractor)- By:--•----_�ZZ .<4G' -----------•---------------------------------------•------------ ---------------(Title)----- (Plot plan, showing-size of_.lo} �ocation.a yste n relpfion_.to wells,buildings,.-etc., can_be..placed_on,reverse_side).T FOR DEPARTMENT USE ONLY -' APPLICATION ACCEPTED BY---------- - -- ------------------------------------------------------- DATE__ ------------------- REVIEWED BY ----------------------------------------------- --------- DATE-------------- •---------- I BUIL DING PERMIT ISSUED :---------•------------------------- ------------ ------ DATE Alterations and/or recommendations:--I----- ------------------- -•---------------------------------------------------------- ------- `_ --_: _CLQ----------4.8167, �b-----TI-R-0 ` :.. ------ ------ ------------------------------------------------------------------------------•-------------•----------- ------ FINAL INSPEC N BY:.. i--- ------ --- Date-----------------9:"_72!=n_45 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES, REVISED S-59 2M 5-62 ATLAS t