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FOR OFFICE USE. t--_ _- --— APPLICATION FOR SANITATION PERMIT Permit No. -....••._.•.. ---- ------------ -- (Complete in Duplicate) �I 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. [(U 3- 200-- 3-2— JB ADDRESS`AND LOC TION. r ------- ----.' _.... . i!� ----- Owner's Name / ------ -----;4 Pone.---- Address ne. Q � 1. Address---------•------•- f:•• r //�....._. i. ------ �--------------------------•--- ••-•--.._...------.•...----------••----•-•. Contractor's Name----------------------- G/t -9L4!2r:- --------------- ------------------------------------- Phone----"-"=-........................ Installation will serve: Residence [,Apartment House .❑ Commercial ❑ Trailer Court ❑ Mote-110 Other ❑ Number of living units: ..___ Number of bedrooms ---!3- Number of baths __/.._. Lot size ......... :.. s__ -- __ -_-_ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth To Water Table _ ._ ... ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa y Loam ❑,. Clay Loam❑- Icyy❑Adobe a-"Hardpan C]Previous Application Made: (If yes,date--------------------) No Ell,, New Gonstruction: Yes No ❑ FHA/VA: Yes ❑ No.05--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s�wer is available within 200 feet.) I Septic T Distance from nearest well_ndr.__o----Distarice fro foundation___ _.. Material_------------------------------------- -- -- - No. of compartments---._._.--2------_r SizeZ7WCe;f"__is iquid depth Uor ___ '____-_Capacity----- , p� - 9 - /� I----Width of trench---------a2-g ------- .. '.� Number of fines______________ - -Length of each line_._:______�`�/�� -' � `-F� IS r Disposal Fi Id: Distance from nearest �w•+ell_._. Distance from foundation______ Distance to nearest of in ...___ , 1 Type of filter matenalc ,ft c[�_!Depth of filter material____l�____!__._Total length___--..__..•________________________j.__ ? Seepage Pi Distance to nearest well------ ------------_Distance fro. .f n tion_._/�_._:__=Distancp to nearest lot _ , line_____ _____:_:. Number of pits_____--- _�--------Lining materia �__ _ ize: Diameter.__ -----------.2,5_�-- -•. 1 0 Cesspool: Distance from nearest well_________________Distance from foundation..........: ____-_.Lining material------------------------------------- ❑ Size: Diameter---`1 ----------Depth - -�--�--------Liquid Capacity----------------------------gals. � Privy: Distance from nearest well_________________________________________ ______Distance from nearest building____________________-___-______....___ ` ❑ Distance to nearest lot line-----------------------------------------------------------•-•-•-•------------------------------------------------------------------------- Remodeling and/or repairing (describei------------------------------------------------------------------------------------------------..................................................... ' O !- ---` - ------------- -------•--------•----•----•--------•-----• I-•------------------------------------------------------------------�'--•-- ----•---•--•--------------•--------------------------------------- _.__..--------------------........------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will7 be done in accordeoce.with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District' , /4�7 (Signed) -- ------ . --• -------------------------- =-^ ------`------ ---------.(Owner and/or Contractorl B --- ------------------ � -------------- ------------------------ ------- �--------- ills .__--. ---...----.------------- ------------- .. .,� (Plot plan, showing size„of lot, location of system in relation to wells, buildings, etc., car' be PIac-47 on reverse side). 0 ' FOR DEPARTMENT USE ONLYt APPLICATION ACCEPTED BY = rrAr.,�..-,.«.-.--------- , _ DAT ---------------------------------. ��----------------- h� REVIEWEDBY--------------------------------------------- -------------------- -------`1-------------------------------------------- . DATA ^ BUILDING PERMIT ISSUED--------------------------------------------- 7- Alterations and/or recommendations:l______________________ ”' _-___.______ �_ . --�� __________ _�_V__.`is-.__-.-_._---`-. ___. -. - +T'L-._---------- _ -----------------------------------------.----------------------.---------------.-__`_______---- -----------___________---------------__________------------------------------ ----------------------------------_________--------------_---------------------------------------- \" I ' FINAL INSPECTION BY: -� 1---------------------------------- Date--------` lq ---------------------------------k---..... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street E 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California I Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS -" 1 1