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FOR OFFICE USE: I - 3 -------------------------------------------------___---- APPLICATION FOR SANITATION PERMIT Permit No. ..,1.�`.__ � ------------------------------------ (Complete in Duplicate) - --- This Permit Ex ires i Year From Date Issued Date issued ..... _ ; Rhx j- osv--�? Application is hereby made to the San Joaquin Local Health District for a permit to construct and install he work herein de crbed. This application is made in compliance.with County Or.' izN 7l4q. N � •� fit` r� ��:- � • JOB ADDRESS AND OCATION--__Sf_D _ lr�D� t �, "C� , Y Owner's Name--------- - ------r---------------- ----------- -------- ------ Phone.................................... �j Address__. . r !"�. Q ---------.07-------- . '---------------- -- ------------------- Contractor's Name C ."�--- _.. .... i Phone................................... --f9 --- -------- ;-- Installation will serve: Residehe Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____.-. Number of bedrooms 3_. Number of aths __1 Lot size - . Water Supply: Public system ❑ Community syste C❑ Private Depfih TO,Water Table _ . ft. Character of soil to a depth of 3 feet: Sand a Gravel ❑ Sa dy Loam "Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date.._�__.______.__-_.) No New Construction: Yes �o ❑ FHA/VA: Yes ❑ No ❑ TYPE.OF INSTALLATION•AND.SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Ell' .- Distance from nearest well__, L?.__Distanc from foundation"_"� 0 0- ._.Y;s �r al.. - . _ Q.... :... No, of compart menls__.__-� :_-......Size-__ X_ - _�Si uid de th.__ ©Q q P. Capacity I� -- d Disposal ield: Distance from nearest well--SU-.--Distance from founda*ion---/-09-_--____ nce to nearest lot li e._-_��_-..... . Number of lines__.l _ Length of each line_ ___. .............i� Width of french.__--3_�2.... ,x�r -._--- Type of filter material O. i4___Depth of filter material_______ .T___.___"Total length______________________��' Seepage Pit: Distance to nearest well_____________________Distance from foundation_______.............Distance to nearest lot line________--_.--___ ❑ Number of pifs_____________________Lining material_______ Diameter__._-..._____--.-_____ - Depth--------------------------------- Cesspool: Distance from nearest well----------------__Distance from foundation..._._____.______.Lining material..________..___ El Size: Diam --- efer- ---- -------------- -- ---------Depth---_:---------------- -------------- ------Liquid Capacity.........------------------gals. Privy: Distance from nearest well_________________ .________-_' --------- -------Distance from nearest building ------------------------------------------ Cl Distance to nearest lot line----------------------------------------------------------------•-- Remodeling and/or repairing (describe ------------------------- ------------- fit' --------------- ---------------------- _..� _r. _ Y _ = i - ---"---•---------------- --- - • •-----------•-----------••---•------------------------------.:__._...•-------------------------------- I t I hereby certify thaf I have pred.i'Itis,application and that the',,work will be done in accordance with San Joaquin County ordinances, Sta laws, rlesneg�ulatlops the San Joaquin Uocal Health District. (Signed) --- ------ r ------------ -----------------------------------------(Owner and/or Contractor) By:- ----------------- -----•----------------------_----------------------------------------•__._(rT fl;� -------_ ----------- .............. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY------ -------------------- ---------------------------------------------- DATE-------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE--------------_-- BUILDING PERMIT ISSUED-,------------------------------ _ -� :,_ ................ DATE----------- Alterations and/or recommendations:------------------`" ' --------------------------------------------- --------------------------------------------- ........................ , -----------------________________________________ ' .____"________________________________________________ _____ ..-____"_-____.___ ------------______-------------_........____...... FINAL INSPECTI -- . --• -- ---- ------- ---- Date------- --------------------- s ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street 4 Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5.62 ATLAS-