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FOR FIC SE: Rle_4 --J_s---' �-- --..- af� APPLICATION FOR SANITATION PERMIT Permit No. .. ...... .....!- ----------------=---------------------------------------- (Complete in Duplicate) y 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. 22 .. JOB ADDRESS AND ATiON_- �Jf---620'.- - ------------------------------------------------........--------•----------------------•--••.............•--•------ Owner's Name-------------- ---- ----�s--�P..Y...... - -- --------•-----...------------------ ------------------------------------------------------------=------ Phone---------_----------------------- Address....................... ----_-------------------•---Address----•-----••-----.-•--- . . -- •--- ----------------------------- -----------------•----•-------------------•--- f,�,, Contractor's Name-------------------- ruf/r:/ -- -------------------------------------`----•----_------------------ : Phone----------------------------------- Installation will serve: Residence ❑� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1... Number of bedrooms .-- --Number of baths ........ Lot size _./ _ d1 ----•_••_______________ Water Supply: Public system [Community system ❑ Private ❑ Depth To Water Table _IOft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe 23"'Hardpan ❑ Previous Application Made: {If yes,dote-----------------_.1 No 2,' New Construction: Yes ❑ No [ice' FHA/VA: Yes ❑ No ERI TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) E t Septic Tank:` Distance from nearest well_________________Distance from fougdation----------.._.-...__.Material---__--_______.____________-------------_------ I !�rvf No. of compartments--------------------------Size1....1----------------------.-.-Liquid de th----_-------------------.-Capacity Disposal Field: Distance from nearest well-...!� - --__Distance from foundation.i_��_A..•.._.Distance to nearest to line.- _4 ine.- �f._.... Number of lines________/ -----------------Length of each line-------0 _____--_---._.-Width of trench_�________________________ Type of filter material -r X04—Depth of filter material.__.�e __--_-__Total length__________p___----•_____________________ Seepage Pit: Distance to nearest well........_ -----------Distance from fo}}j�ndationk__,ZA-------Distance to nearest lot line__-s��_-..... []/" Number of pits___.-_I------------Lining material____�JP.G/ ___-Size: Diameter_._.,?wq_-.......... %Y Cesspool: Distance from nearest well-----------------Distance from foundation----------------.---Lining material------ W ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity.............---------------gals. Privy:, Distance from nearest well---_-------------------------------------------._Distance from nearest building-----------.------------------._._.____._. Distance to nearest lot line_----------•-••---°----- - ---------------------- --------------------------- -...----•------------------•---------------- �1' 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 regulations of the San Joaquin Local Health District. ' _______---_____._.( Wor Contractor) 'Signed}---------------------------------- - - ------- - - - ------------- ------- --- --------------------------- -- Title.._ By: ( } (Plot plan, showing size of lot, location of system6i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- `�~ - ______________ DATE_. ----- - ° r: ------ ----------- ---------`------------ REVIEWEDBY------------------------------------- ---------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------- -------------- t-------- ----•----------------- ------ DATE----•V•---�-------G----:--- Alterations and/p n n -------- - -----------------------------------_ ____---------------------------------------------------------------_----------------------------------------------------------------------------_-------________________________________ FINAL INSPECTION 'BY:..... 7 -- ----• / y'�"--`_":--- ------- Date------. `---------�-�-----�--------------------------------- ! SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Watt Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California r ES 9 REVISED 8-59 2M 5-62 ATLAS'S