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�— I-UKUrFICt U5E: G ---------- ----------------------------- -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._.� 5. ---------------------------- --------------------------- (Complete in Duplicate) --------------- -------------- ---------- ------ ------- This Permit Expires i Year From Date Issued 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- 7-H 7 JOB ADDRESS AND LOCATION---101= Owner's Name--------- ---------- -)Z� ✓ ---- ------- Phone.................................... —_�"`- �� / ` )---------- `'-----------___ Contractor's Name _P__ --_ ----------------------------------------___---------------------- Phone................................... _ Installation will serve: Residence Apartment House E] Commercial L] Trailer Court E] Motel ❑ Other E] I' Number of living units: .... Number of bedrooms __/__ Number of baths ..._ Lot size ___� __/ _.% •_______________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth To Water Table -------- ft. Y ,._ - Character of:soil-to..a depth of 3 feet: Sand Gravel El Sandy Loam ❑ Clay Loam ❑ Ciay ❑ Adobe❑ Har-dpan'❑ ��° Previous Application Made: {If yes,date--------------------} No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4" -0 C# '1 (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) I:!, Septic : Distance from nearest well---'-',,, well___,-- �_-n-�•--Dista fF m foun�ion__.../0-____-Material---/ � �CK No. of com artme#is I"e ......Liquid depth - ----CaPaci tY 1 0-_Z------ - .i Disposa Field: earest we x ---------Distance fturn yf ound--a-.t.i.o---n__._-_•j0....... .Distance to nearest lot line...._ .__...... Number of InesiI Width of trench ............... Type of filter material, -j ____ 4&teriaI_.___/ . length______________ -%--_-_-•- Seepage Pit: Distance to nearest well--------------------Distance from foundation_____________...__-.Distance to nearest lot line___________-___-- I ❑ Number of pits----_------------y---Lining material-----------------------Size: Diameter------------------------Depth----_------------_•------------- Cesspool: Distance from nearest welh.---------------Distance from foundation------------------_Lining material_____________________----__________ ❑ Size: Diameter ---------------Depth---------------------------------------------------Liquid Capacity............................ Privy: Distance from nearest well_-_- ____---------------- _______________._Distance from nearest building------------------------------------------ ❑ Distance to nearest lof'line' 4 +. �+ : rarer ,,f es and/or repairing (describe): ------------------------------------------------------ Remodeling _' -----_::---•-•-------••.--------------------------------------- -------------I------------------------------------------------------------------------------------------------- ------------••---•-------------•-----__----------••-----------------•----------•---------------------•---------••----------------------------------•--•---------•-----•-----------•---•------- ----------------- •-----•----------••-•-------.-------------•--•------ ----------------- ----------------- 1 ------ ---------------------- •----------------------_---- -- -- -----,----------------------------------------------------------- ------------------------------------------ -- -------.----• ----- I hereb cerci. ,�t I have re ared thisapo IIcation and that the work will be done in accordance with San Joaquin County ordinance;, S:a# and if and-regula`mins of the San Joaquin Local Health District) {Signed}_: -------_-------.......--------•-------- -------- ------------------------------------------------------------------------------------------------{Owner and/or Contractor) I By: ' --------------------------------------------------------.. •-•--{ 06)-------------------------------------------- - (Plot plan, showing size of lot, 16' 'o. of system in relation to wells, buildings, a#c., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY1.r.7�__ _oR4-0 ---------------------------------------- ' DATE------ _�_ L- ,�� REVIEWEDBY------------------------•---#------------------------------------------------------------------------------------------------ DATE------------------- BUILDING PERMIT ISSUED-•---�----------------------•-•--------------------------------. --------------.__------------- DATE------------- Alterationsand/or recommendations:-------------------------------------------------------•-•-------------------------•-----------•----•-•---------•-------------••---•-------•----------------•-- ----•-•----------_-•--------------.............. ------------------ --- -----------•-------------------------••-•--------------•-----•-------- ....................................... ---------••-------------------•--- ------------------------------------ -------------•--------------...---..-._..-..._-.-. Date � t: t �� FINAL INSPECTIO v 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 2M 5-62 ATLAS