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/ FOROFFICE USE f 3�� -------- > -�- ------------ -/-,-.� ------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------------- (Complete in Duplicate) --------------------------------------------------------- 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 with County Ordinance No. S49. 4f ds-o 2.JE . JOB ADDRESS A CATION--__._--L ------- � j 3 t1i-- /-73— ----- . Owner's Name---------- 1 n"`� ► -------�0 -C--�-Z_J t---•---------- ----- --------------------------------------- Phone_................................... Address----------------------------- r� c �+ � ....._..... Contractor's Name-------�� t6-�----...-- ------ ------------------------------------------- Phone..........................--------- Installation will serve: Residence ❑-`*`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms .:�--- Number of baths _� Lot size .101-X-72 a.X.//115_. '..17--f Water Supply: Public system ❑ Community system �ivate ❑ Depth To Water Table 61sr-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑, Clay ❑ Adobe®�ardpan F]Previous Application Made: (If yes,clate_- _----._.--) No [� New Construction: Yes �o ❑ FHA/VA: Yes P-"`No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available-within 200 feet.) J Septic nk: distance from nearest well_._Distance from foundation._/49--------.Material... Gr 1.�..rl�._.......... No. of compartments------7 --------...Size.__ "�.yQ..�..-Liquid de th,-- - � Ca acit "V Disposa geld: Distance from nearest well----es_--_--_Distance from foundation... --Q Distance to nearest lot li e.6.1.......... Number of lines--------Z. Length of each line._�j _...Width of trench.,�_V. ................... ------------ 9 f �� YP /�:- - p if ...............Total length_-��- T e of filter material.... t>,_�C..,�pe th of filter materia .. •J_-•------------------• Seepait: Distance to nearest well-_-..W�...___Distance from foundation-----1_ -•- 16.!...... to nearest lot line..._t-�.....-...- y, Number of pits......;,,---------Lining material. C. ....Size: Diameter.23.I-----------Depth.v��--1- l.... Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material..............- p ❑ Size: Diameter-------------------F-----------------Depth------------------------------ ---------------------Liquid Capacity--------------... ----....gals. Privy: Distance from nearest well......................................... .......Distance from nearest building----------------------------------------- El Distance to nearest lot line- ---------------------------------------------------•-------•------- Remodeling and/or repairing (describe)----- --Ale- —-------- .1ej_ol.� /-5;�-----=` zj'-sre_,_jj----------•--•-•---------•-•........................ ----------------------------------------------------------------------•--------------------------------------------------------------•-• --------------------------•--------.---------•-------------•------------------------ --------------------------••--•--------------------------.-----•--------------•------------------- ---------------------------------------------------------•---•----•------------------------------------ •------------- •-----------------------------------------------------------•--------------------------•--•----------------••-•-•-----------------------------------•--•--------------------------------•---------------------------------- hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, S a e s, and esi reg lations of the San Joaquin Local Health District. ------ .. _ (Signed) .• - - - --- - - - ----------- --------------------------------------------------- ---(OWner end/or Contractor) � By---------------------- ---- -----------------•----- .....(Title}. --.--.. -------------- (Plot plan, showing size of I , afion of system in relation to w s, -uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- -----------------------------------•------••----•----------- DATE..------ REVIEWEDBY-------------••----------------------------------------------------------------------------------------------------------- DATE---------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------•-- DATE.------------------------------•----.._.. Alterations and/or recommendations:-------------------------------- --- --- ---------____------------------------------------------------------------- --•---•--------------------------- ----------------------------------------------------------- .... ---------------------------- -------A�-.3Z_ -fly----F- - 0,- ----------------------------------------------- � ---------------------------. - ----- ----------------------------------- �---- � FINAL INSPECTION ----------------------------------- Date------1�-= --. -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVI5ED 8-59 2M 5-62 ATLAS