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FOR OFFICE USE:--------------------------------------------------------- ' v --__-- --------- --------------------------------------- JZAPPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (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. ma ------� � �... JOB ADDRESS AND OCATION----- -- -�---- ---- -- •-- -!--- --•=------•_........---•----------------------------------------------•------------------._._.:.... Owner's Name. l:�- -------------------------------- Phone----------------------------------• Address--...............k t`-'•-•------`�:.TJ0j -= I Contractor's Name...............G C4�Y�L • Phone ....... Installation will serve: Residence T[— Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...___ Number of bedrooms —2-- Number,ofbaths ___1___ Lot size ....... --------------------------- Water Supply: Public system ❑'Community system ❑ Private ❑ Depth to Water Table -?L ft. j Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0-Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date____________________ No [� New Construction: Yestj'No 0—FHANA: Yes ❑ No 0— TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__LU�e-----Distance from foundation__/�_-----------Material....-___-��_hcr ........................ ❑r No. of compartments-------_o------------ f-- -----------Size.---.....-H --------:---Liquid depth------�4t------------Capacity.... 3 ? �� Disposal Field: Distance from nearest well-A.IL�',_-_._Distance from foundation__PL>__--_______,Distance to nearest lot line.....�5......... rte' Number of lines..--.-____j�------ ------------Length of each line �_: �_�'` S.Width of french------2__------------------------ R' r Type of filter material_, eQef Depth of filter material----!__e_-`_________Total length_________IQ.......................... Seepage Pit: Distance to nearest well_A�--------Distance from foundation._a�...........Distance to nearest lot line...... ❑' Number of pits_ ___________Lining material_ ± -.Size: Diameter.V!`_,� -------------Depth___.... _'--------------------- Cesspool: Distance from nearest well________________Distance from foundation____________________Lining material--------------__________________-_-_ ❑ Size: Diameter---------------------- ----- ---------Depth----------------------------------------------------Liquid Capacity -------_-•---------------gals. , Privy: Distance from nearest well_________________________________________ _______Distance from nearest building__________________________.____________-_. > ❑ Distance to nearest lotline---------------------------------------------------------------------------------------------------------•-••----•--------------------------- Remodeling and/or repairing (describe):----------— ------ _----••-•---------_--......--•-..._................................................ ....................•-------•-------------•-•-----.___-•------•--•---••-------------------------- ......-•-••-•----------------------------------••---•--------•--------••-------•-------•------------------------ i -•-----•-----------------------------------------------•--•-•--------------•-•-------------------•---•---•---•-•-------------------------•-----------------------------------------------------------•----------------------- ---------------------------------------••-------------••-------------•-----•-- ------------•------------------------------------------------•--------------------------------------•------•----------------------------------- 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 the San Joaquin Local Health District. ( -g )---� --------------------=--------------- ----- -�-----------------• -- -- -------------------------------------------------------------------(Owner and/or Contractor) (Phot plan, showing sizd of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ; FOR DEPARTMENT USE ONLY i o APPLICATION ACCEPTED BY- -------rte----------------------------- ---------- •---•------------------------ DATE____-----/l-/l _- •. REVIEWED BY DATE �� _ BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------. D,4�TjEl -j - Alterations and/or recommendations: ----•---------A, ---------------------•--•------- r ------------- _ ----------- •- -••----- / Ar FINAL INSPECTION BY------------------ ---•--- ---------•----- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 5-59 PM 5-61 ATLAS