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FOR OFFICE USE, ---------------- ------------------------------- ------------------------- ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------•--------------------------------. (Complete in Duplicate} Date Issued --------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the S6n Joaquin Local Health DiAricf.for a permit to construct and install the work here're described. This application is made in compliance with County Ordinaince-' No. 549. LOCATION.'JOB ADDRESS AND 0 U I ........ .......... ............................................................................ Owner's Name........................... �' N_F�TJ4---------T�---------R-0.1-3-T�'.R_---T-5.x2ij---------------- Phone----------------------------------"" /_0 U I Sj�= Address........... ------------------------------------------ Contractor's Name-------- ......---•--••---------------------•------------------------•-------------------•----•----•-- Phone----------------------------------- Installafimn will serve: Residence ff-�Apartment'House 'E],- C;oFWmerciaI [I Trailer Court [3 Motel [] Other El Number of living_u.nLit!: j dro&s- ��_. A.6mber.of-_baths Wate�r-gui;p'ly:—'p'u6llc-''sys'fem 0 unity syst [] Private th - Water Table In ft. . T m Character of soil to a depth of 3 feet: Sand �7ravel E] Sa d Loam Clay lay Loam E] Clay [3 Adobe 0. Hardpan 0 _Previ!us -pp icafion Made: (if yes,'date-------- ----------- No New Construction: Yes �o FHA/VA: Yes D 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 arest well-----------------Distance from foundation.............!__Materalt t /V&— No. of compartmerifs-----------------------_Size-------------------------------Liquid depth---------------a------------_Capacity -------- --------- Disposal Field: Distance from nearest well___- Distance from foundation......10--------Distance to nearest lot line_..57.."... Number of lines-:...I ---------Length of each line_______ _" 1, Y ------- Midth of trench--------36-11 ----- ------- -- ----------------- 460 �_ - C\v Type of filter materiaI._.)?0_CK----Depth of filter material_.__ !%t_al length---------- -----_------------------ Seepage Pit: Distance to nearLtlwell--------------NpftDistance jrp.�.I_fou.ndation-------------!._.Distance to nearest lot line....._........... � I le — - - Number of pits......................Lin1ng maferial.,-------------------- Size: DiametJ---_-------------------Dlh et -------------- ------------------ ❑ I i t5gis 1)0f1QVkk Cesspool: Distance from nearest well.,ZS 'i",r ---- tince from f6undafion---------------!-----Lining matea - ------_------------------------ Size: Diameter--- ----------------------------Depth-------------------------------------------_I.-Liquid Capacity..........-----------------gals. Privy: Distance fromnearest ------------------------ Distave-from nearest building---------------------------------------- F1Distance to nearest lot line____________________________------------------- jv ------------------__---------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------•- --------------------------11----------------------------------------I------------------------------------------------- ------------------------------------------------------------------------------------•-------------I------ ------------------------------------------------------------------------------------•----------------•-••• ;I L. --------------------------------------------*---------------------------------- -------------------------I------------------------------------------------ ------------------------------------------------------------ .......----------La I hereby certify that I have prepared this application andAat the work will be done in accordance with San Joaquin 'County ordinances, State laws, and rules and regulations of the Sanooaquin Local Health District. (Signed) -------------------------------------_ __—-------------=-.(Owner-.,and/-or-.Contractorl-. By:--------------------------------------------: ------------------------------ ----- ----- -------I----_---------------------(Title)------------------------------ --------- - - - ------------ (Plot plan, showing size of lot, locafiort of system tri-rerafiolrot alis, buildings, etc., can be placeJoOon reverse side). "FOlk ,PEPAqTMENTUSE ONLY APPLICATION ACCEPTED 1 51 ------------------ 7A -------------e�--------- K --------------- --------------------- REVIEWED BY.......................... --....._.:A__... DATE --------- ..........----------- -A------------- BUILDING PERMIT ISSUED.------------ -------- DATE------J-, Alterations and/or recommendations-----------------------------------' -------------------*.......... )c------------------------- --- ------------ -------------------------------------------------- --------------- ---------------------- ---------------------------------------- ----------------------------------------------------w----I , -----w--------:---------------------------------------------------------------------------------•--------------------------•---...._.......-------------------1------------------------- ......!..�------- ------------------------------•--••-------------------------.---.---•----*------------------------ -------------------------- ........................... .. ....---------------- ------------ ---------------------------------------------------------------------- -------------------------- ----------------------------------------- -------------------- ------!.I------------ ---------------------------------------------------------- ------------------------------ FINAL INSP Date----------- -------------- - ------------------ 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 ES 9 REVISED 8-59 2NI 5-6?_ ATLAS