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____________________ e --- .._.. J/ ,f 1___1 - � y APPLICATION FOR SANITATION PERMIT Permit No. ----------------- --------------------'---- (Complete in Duplicate) JJ --- -----------' --------------------------- ---- --- This Permit Expires Year From Date Issued Date Issued __0/_l-.�41/ 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. JOB ADDRESS AND LOCATION _ - 77.--__6„_---W T' .r- 11k R1 lT A _ ------------------------------ Owner's Name.- I - L7--�'MA•-•--.. Phone Address - � M ------ ----- ----.................................... Contractor's Name------- ...QI�'Iv- - .. - --------------------------------•--------. . Phone................................... Installation will serve: Residence Apartment House E] Commercial ❑` Trailer Court. ❑ -Motel ❑ -Other f Number ofliving units:,:..-:,Number of bedrooms..- Number of aths .-___ Lot size _.. ____X.__.. ��r5.............. .. + Water Supply: Public system ❑ Community sysfem ❑ PrivateDepth to Water Table/9—ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes 0",'No ❑ FHA/VA: Yes ❑ No� TYPE—OF1N8'iYALIrA-TIOW AND SPECIFICATIONS:' (No sepfic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tartk:�fistance from nearest well-----------------Distance from foundation---------------- ( N ot" compartments---------- ---------------Size------•----------- -= -Liquid depth- -- Capacity F Disposal Field: i from nearest well... _ _.-Distance from foundation___AC....._._.Distance to nearest lot line--- - Number of lines___.______---_--__-- Length of each line._____ .__ 5'__ Width of trench.-. 2y y x•-••------- � ` t Type of filter material.' l:� �'�-----Depth of filter material.____ ______.___To}al length.........'.......... . Seepage Pit: Distance to nearest well----*"-------------Distance from foundation-----------.........Distance to nearest lot line........--------- oo mbarof piti...___ _•----; •-__4 Lining material-------------- Size: Diameter--._.----••-------_.-__.Depth------.-_------.-_- _---.----- Cessp l: atN Distance from nearest well_ ______________Distance from foundation___._.___._..______.Lining material.............. _ ❑ Size: Diameter-'------------ ----------------••----Depth--- ------------------------------------------------Liquid Capacity gals. . Privy: F Distance from nearest`well-_________ L _ __.__Distance from nearest building ... ❑ Distance to nearest lot,line-----------------. - _.. ... Remodeling and/or r pairing (descLbe):_____'-4----------e-CN --------- Psi 1 : . . _ f -._..._.__ , I . -- -----••----------•------•-----------------------•-------------- - --------------------------------------herebyY cerfify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,'+State laws nd,rules and regulations of the San Joaquin Local Health District. _r4 —r...__ ------------------- (Signed). Owner and/or Contractor) I BY: =--------•---------------------------------------Title - ---------------- - - ------------------ (Plot plan, snowing size'of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - r f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY J<-- I _!-��------------------ ------------------------ ---------------I..--- DATE...... -•----------------••---- REVIEWED BY-------------------•------------------------- -------------••--------------- --------------------------•----------------...._. DATE------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------ ------- --•-- DATE. Alterations and/or recommendations:--__--_.__.____- ._._ FINAL INSPECTI - -- - --- ------------- ------ Date-- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 Wort Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5.59 2M 5-61 ATLAS n.