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FOR OFFI E U E: --------------------------------.--------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------- ------------- -- ------------------------- (Complete in Duplicate) SJ ------------ -- -------------------------- ------- - Date Issued - -- This Permit Expires 1 Year From Date Issued , jApplication 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.-___.__7: 09 -/4 �'�P.E�--��------------------------------------ - Owner's Name...A7!4 ....._. 1 'E:T ---------------------------------- -------------------------------- Phone/ XQ: l.. Address-------- L ----•-•--------------------------------------------•-•---------------------------------•-----------....................... Contractor's Name-.-------:. i,1 9•-.e,410- ----- ----------- •----------•-•-------••--•--•--._...-•--•--- Phone/��.--•-•-- Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- ..`7-- Number of bedrooms 3____ Number of baths _ _. Lot size .. _--_`___ Water Supply: Public system ❑ Community system ❑ Private Er-Depth To Water Table VS`ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe41`Hardpan ❑ Previous Application Made: llf yes,dl ate.-------------------) No P?`�'New Construction: Yes ❑ No El"'_FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool p;rmifted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material _____________...._____..._____._...____..___.__.. ❑ ex�X-t No. of compartments-------- ------------Size------••------------- ---------Liquid depth--•----------- -----------capacity Disposal Field: Distance from nearest well__ _1._.._Distance from foundation-----I_V.......Distance to nearest lot line... � f" I , ,, -•-•- t ❑ ,� Number of lines_.--------•?--------------------•-Length of each line-------.---� ...-.------.Width of trench...------,�.—_Y...-----------•- per' type of filter material._�1G_A<------_-Depth of filter material____J_k"`-----:Total length------------ Q_!------------------- V Seepage.Pit:. .- Distance to nearest well________________ Distance from foundation..._ __ b' � - ---- Distance to nearest lot line__'��-___ �'�i Number of pits-_'__� '-__---Lining material_.. ---Size: Diameter__--------- Depth____._._'=- Cesspool: Distance from near`est-well---------'__.'Distance from foundation--------_------------Lining material--------------------------.-.______._ ❑ Size: Diameter-------------------------------------'Depth----------------------------------------------------Li uid Ca acial q P tY..... ---------9 s. 1 71 Privy: Distance from nearest well________________'_______..._______.______.______Distance from nearest❑ building Distance to nearest lot'line = ... --------------------••--------•-----_ Remodeling and/or repairing (describe):_ __ __-,f5,Q,P___.__ 0...--..4-eK S'Ti xF--------- knx t -------------•--------••-------------------•----•--------•---•---------••-------•------------•-----•--- - ------ ------•--------------------- -------------------------`------------------••-•------------------------•---•---------•-•-----------•--------•-•------------ -•-----•---------•----------------------------------- 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. �j 1 .` I (Signed)--__-------_ �_ _,---f/�' ------.---------------------------- Owner and/or Contractor) gY� � _ _(Title)__ (Plof plan. showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY r • APPLICATION ACCEPTED BY---- rt - ```-- ----- DATE--- Z REVIEWED BY----------------------- ----------------- ------------- - - DATE --------------------------------•------- BUILDING PERMIT ISSUED_----•----------------- - -----•----------------------------- DATE-------------------- --------------------------------------- A erations and/or recommendations:---------------------------------------------- ----------- --------------- •----------- ------- •-------------------- ---------------------- - --(------------------ ------ FINAL INSPECTION By. Date--- /- i--- /�9 " A .. ....... --------- SAN IN LOCA 130 South American Street 300 West Oak Street 124 Sycamore Strut 205 West 9th Street Stockton,California 1 Lodi,California Manteca,California Tracy,California ES 9 REVISED 13-59 2M 5-62 ATLAS __ J