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AOIOFFIC�,U�S Permit_No. .13.....�.... APPLICATION FOR SANITATION PERMIT I 4 ---------- ------------------------ (Complete in Duplicate) 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. { ® 1. -----------•..................... -....-. JOB ADDRESS AND LOCATION---!-�-�0'"'_---�---- r --- '�---------•-----------• I Owner's Name. ---- Phone------------------_------------- .---� 1 Address----------- ice. - --- ------------• --- = -----•--•-- Contractor's Name------------ ..... Phone-------------•---•------------.-. Installation will serve: Residence [F-Apartment House El Commercial E] Trailer Court ❑ Motel ❑ Other [-I Number of living units: ..(____ Number of bedrooms !---- Number of baths 1----- Lot size _�`:_�--!G _g�•---------••---•-•-••---••• •- p Water Supply: ,Public system community system ❑ Private ❑ Depth to Water Table SO- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8---Hardpan ❑ Previous Application Made: ilf'yes,dote-------------------I No [I New Construction: Yes E] No'❑ FHA/VA: Yes ❑ No [3i `• . TYPE OF INSTALLATION AND SPECIFICATIONS: } [No septic tank or cesspool permitted if public sewer is available within 200 feet.] •.�- ! Septic Tank: Distance from nearest well ---..Distance from foundation__lig!------------_Material.________________________________________________ .-•-Li uid de th---y-=-------------- Ca aci °d --Size•Size...-- - P tY No. of compartments_--,__-_�___-___-.- -- � ^x�• 9 R --- Disposal Field: - Distance from nearest well. --Distance from foundation/•P.t.-!~._.__-Distance to nearest lot Number of lines------ =-------- Length of each line-----_-$0-— -------Width of trench------- t*-____------.._.-- t. . Type of filter material.z6 G__I"---_------Dopth of filter material.----_��__'__.__-___--Total length--..-$.�--__�................... ..... 1 foundation....................Distance to nearest lot line_--_-----------__ � Seepage Pit: Distance to nearest well from ❑ Number of pits--•-------- ------Lining material-----------------------Size: Diameter--------------- -------:Depth------------_-•----•------• -- Cesspool Distance from -nearest well-----------------Distance from foundation--------------------Lining material----------------_----_---__-_-__---.- kk Size: Diameter_-', •-----------•-------------Depth---------------------•-----------------------------Liquid Capacity----------------------------9815. It. ❑ •.F Distance from nearest buildin j Privy:; Distance from nearest well-------------- ----------------•----•------ -. g - ❑ Distance'to nearest lot line---- -------------------- ----------•---------------------•---------------•------------------------•-------- Remodeling and/or repairing (describe):------------- -------------•--------------•------•-----•---- --------------------------•------••-----------•----------------L------------------------ -- -------------------•------------------------ ------------ --------•--------------•-•----•---------------•---------------•-----•-------•-----------•---•-------------------------•---------- •- --- ---------- --- • -- - •- ----••-- - 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 e S Joaquin Local Health District. 4 (Owner and/or Contractor] (Signed)_ - -- ------ ------------------- ------ ----------------•----------•-•----- By:_--------------------------------------------- ---- ...... ---- ----- ......... -----------------------------(rifle)-------•------------------------ ............... ................ plan, showing size of lot, location sem in relation to wel , buildings, etc., can be placed on reverse side]. k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED i3Y_ f ------- -- ----------- REVIEWED BY-------------------•----• ----- ---•-----••• DATE--------------------------------------------•--•----------- ------------- ` BUILDING PERMIT ISSUED---------------•------- ----- ------- -------------- DATI=..__.... -- Alterations and/or r commendation - k FINAL INSPECTION I BY:- ..-. _- _ -.�� . �------ Date----------- =�'2`� •----------------•--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED 6-59 RM 6-61 ATLAS