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rUK oFFI E U E: --- � �� -_ ___�`. APPLICATION FOR SANITATION PERMIT Permit No. .l�(�� / `. (Complete in Duplicate) / ---- -- -- This Permit E � x ire, 1 Year From Date Issued Date Issued .__.. /.. '.. Application is hereby made to the Son 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........ •j 1 , ._..._. .= �' 7 .......................•-••-••-• •STi�C�cJ ................. I Owner's Name.---)In --------•-- 1�f�111._�QV_�'`��:_----- _ Phone_ ------------------------ ------------------------- ------------------- Address------------------�T�---��-•3--8-----C-•f--•---�/��t'�2_.� �•-----••-----...__..------ •-•- . ----•-• ... _------- ••-------------•• Contractor's Name............��-_ _�•.-- 1�12 i� c5 -•.._.---•-- . SO-VS ..--/_( ---------------------------------- Phone................. ........... Installation will serve: Residence [j],Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ....- Number of bedrooms _.$-- Number of baths J---. Lot size -__ ._.-X-,2/ V ❑ Water Supply: Public system - Community system ❑ Private ❑ Depth to Water Table .r-� ft...... - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe Q' Hardpan ❑ Previous Application Made: (If yes,date . ) No GO' New Construction: YesNo TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ FHA/VA: Yes El No Q' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from nearest well.................Distance from foundation------------- No. of compartments------ •. •..............Size.------------------------------Liquid depth..........................Capacity p .................... Disposal Field: Distance from nearest well.................Distance from foundation.................... to nearest lot line......... ® Number of fines................ Length of each line..............................Width of trench____.._._...__...___... Type of filter material........................ _.._._...... .Depth of filter material_________________•_,---Total length................................. Seepage Pit Distance to nearest well.../VON ._DistanceAom foundation___------a -.Distance to nearest lot line._..ur...1___ [ C Number of pits......_..j•_.__._--.Lining material.,'A J0. /L__Size: Diamete"J 14ac - t �_. Depth..... .. - Cesspool: Distance from nearest well-----------------Distance from foundation.__.--_. _.__..._.. ------ materiel._._......____....................... -• Privy: Distance from nearest well Size: Diameter.__.. ----- - ----------_-------Depth.---•-••---------------•---•--••------ ---•-•----..Li Liquid Ca i ' q p ty.................•.-•._.....gals. ............................ ..................Distance from nearest building.......................................... El Distance to nearest lot line.......................... 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 Co.unty- ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. .41 (Signed)-------- .�' e�142ct �3 '•--•••-.__'.__.. --(Owner end/or Contractor) By:... -�-� �.. c—_------------- ----- -- - -- -- -(Title)...--- ----_... .- (Plot plan, showing size of lot, location df system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..��.�.. � -<^ti__----- -_ DATE....... ..- f . REVIEWED BY-- ••. /... -------................. . ..... --------------•--------------•-----------------.......-•--••. DATE............................................................ BUILDING PERMIT ISSUED........................ — DATE_._.__.... Aheretions and/or recommendafions:_..._ ..... ---- ----------------------------- G�(/ �— ---- _.._{..................:}-.__--- __ T_ ..---... ...----.Q.-'....-'-..-. .. FINAL INSPECTION BY:._-._.` �• -• --- ? � Date........ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street los West 9,h street Stockton, California Lodi,California Manteca,California Tracy, California ES 9 REVISED 8.59 2M 5-62 ATLAS