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FOR OFFICE, E: ✓ APPLICATION FOR&SANITATION PERMIT Permit No. ..... ...... ........... -------- ------------ -- -------- �j------ (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 wor• herein:.descrlbed., This application is made in compliance with County Ordinance No. 549. ca �� -- ..----•-------------•--..... JOB ADDRESS AND LOCA ON------� � - %. - = { Owner's Name-------------- '- P— ------------ -- ----- Phonelf� ---`� --- ��--- Address-•--------................•----•--..................................... _...------------- --------------------------------------------------------------------------•--------------- Contractor's Name...............................................-----•--::S----e-r .:� - - ----------------------------------- Phone-----_--------_.................. Installation will serve: Residence 4 Apartment House ❑ ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __Z-_ Number of bedrooms -.?-- Number of baths _L:7�1_ot size -_-__---------------� 4t .... Water Supply: Public system ❑ Community system ❑ Private 2 Depth To Water Table/r ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam La Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: llf yes,date--------------------1 No R New Construction: Yes ❑ No [2( FHA/VA: Yes ❑ No 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--_- l1. Distance from foundation----,.t2---------Material_--- - :x�r. --..... No. of compartments--------- .---------Size-------- quid depth......%-_'.-.________Capacity-------- "'-- E Disposal Field: Distance from nearest well-----f'__Distance from foundation-....':7_-�----Distance to nearest lof;line---------- [� Number of lines-------------zf!-�----------Length of each line---------- Width of french----------- -- -- Type of filter material... -_Depth of filter material---� "_-_.__Total length------------------%_- -._sa.-`.. t Seepage Pit: Distance to nearest well----------------------Distance from foundation-__ -___.______...Distance to nearest lot line................. ❑ Number of pits----------------------Lining material---------------------:_Size: Diameter---------------------- Depth---------------------.._--- Cesspool: Distance from nearest well-----------------Distance from foundation-I----------------.Lining material--------. -_-----1 ........ ❑ Size: Diameter--------------------------------------Depth----•------- I----------------Liquid Capacity------------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------_--__------_----_'_--------------- ❑ Distance to nearest lot line--------- ---------------------------------------- '---------------------------------.-:....------------------- -----•-------- Remodeling and/or repairing (describe):----------------------------------- --------•--•----•-------------;------- 1----------_-.------•-------------------------•-•----•-----•----------------- L 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 regu tions of the San Joaquin Local Health District. f -------- Si ned ,/ �? ... _ -----------(Owner and/or Contractor] ( g ]----{/-- t - -(Title)-`---------•--------------- - ---------.-,f- ------------- �Y�---------------------------------------------------------�---• ------- -------�--- ------ -------------•---•--- ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).' FO PARTMENT USE ONLY APPLICATION ACCEPTED BY '!�2��e--•------------------------------------- DATE------------•- y -3---------- REVIEWED BY------------------------------------------------------------------------------- ---------------------------------------------•- DATE------------------'--------I- -------------------------------- BUILDING PERMIT ISSUED ` - ---- ' DATE y;4 �i --------------- ------------- ------------- A2ra ' s an --------------- --:------ -------- ----------••------ --�----•"--'--`--"---�---_--- _--- - ..... ,O/or recommendaf ions: 1-J2 -----------4-- ---- -------- ---------6-.=------- �� -------- s- � -=----- ---------------- ------------------------- --------------------- --------------- ------------------------- ------------------------ ------------------------------------------------ --------•------•---------------------- -------------- ------------------------- "-"-- - ------------------------------------ ----------------- --------- ------------------------------------------ ------- ---------•------ FINAL INSPECTION BY:. . --- yt.�:'r,� ------- Date ��f SAN JOAQUIN LOCAL HEALTH DISTRACT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,Colifornla.--,_ Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5.62 ATLAS _ t