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FOR OFFICE USE- ------------------------------ ��.< '�•-!�-�� '.x t�C r �.�w ,�// - — t -----------"----- ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.'.../ ------ 1`� - (Complete in Duplicate) rio ------------------- -------- ---- - Date Issued / � 3 -- ------ --- This Permit Ex fires 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=Scribed. This application is ma a in complia wi County Ordin c@ No. 549. /Q-Q�J 4"1 �/�. 3�JOB ADORES G �� .^.: 5 A LOCATIO r ✓/�►c<X+/�i/'� ----------- � Owner's Na a--k --- '`' -Aff ,L_ ------------ - -- ------------------------------- Phone__. � �y, -/-�� - x Contractor's Name__ := T 1�.� 14 -- � `--- -- Ph( ----------- Installation will serve: Resident partment House ❑ Commercial ❑ Trailer � - Motel F-1Other ' Number of living units: _:__--__ Number of bedrooms .__-___- Number of baths /__ Lot size - Water ,Supply: Public system ❑ Community system ❑ Private ❑. Depth To Water Table_ ft. Character of soil to a depth of 3 feat: Sand ❑ Gravel ❑ Sa=ew am ❑ Clay-Loam ❑ Clay [] Adobe Hardpan [] Previous Application Made: (If yes,date--------------------) No Construction: Yes [] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p ptic Tank: Distance from nearest well.A4'� Distance from foyuciation.-� e No, of compartments.._____--___.- Size � r . Liquid depthIr--------------Capacity-- - i Disposal Field: Distance from nearest well-----------------Distance from foundation-------_------------Distance to nearest lo+ lin e__---- ❑ -----------Number of lines------------••---------------------Length of each line------------------------------ of trench-----.....----------_ Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------ --- ----------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------- ---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------------------------------------------ -------•-----------------•_-- El Distance to nearest lot line_________________________ Remod ling and/or repairing (descri e):---_-- ----------t------- 1- 4 -•--- ----- ----- --- • .. -------------------------- --------- ••--------------------•----- -----•------------------------------•-------1------------------------------------•---•-------•-----------------------------••-------------------------------------•---------•------- .-------- .-._ 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. (Signed)-------------------------------------------------------------------------------------- ------{Owner and/or Contractor) By---------------------------------------------------------- -- (Title) of plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.....- ,�7_,__-__ --_--_ ---------------------------------- DATE------- l 6 ----------------- VIEWED BY --------------- ---------------- ------------------- ----- --- --- -- DATE ----------------------------- ---------•-•------------ UILDING PERMIT ISSUED...... ----------------------------•------ DATE.................. ----------- AFFeratians and recommen dtions:------------------------------- - - _ - � --�a�_ _ _�______. .._.i� / .___ FINAL INSPECTION BY:.----- --------------------------- SAN -- ----------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street ZOS Wei}9th Street Stockton,California Lodir California Manteca,California Tracy,California ES 4 REVISED 8-59 2M 5-62 ATLAS - �r i