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FOR OFFICE USE: low" o00-0-1 ------------------------------------•-------------------- JJ / �5 -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....L.-...�.�l... ------------------------------------------------------- (Complete in Duplicate) ate Issued Date Issued ------`_:!._!C . .6 - is Permit Expires 1 Year From D,, Application is hereby made to the San Joaquin Local Health District for a permit to constru�install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCA ION -1 - �- Z 1 ... Owner's Name...'% x> - --- Phone.................................... Address------------ im. t�......... -Gw..... ............. •----------------------- --•-•----------•----------------------- Contractor's Name..�V._1*x'. -...-•-------------•--------------------------------------------------------------------•-------•----------.._. Phone................................... Installation will serve: Residence PJ Apartment House ❑ Commercial ❑ Tre iler Court ❑ Motel ❑ Other ❑ Number of living units: _t_____ Number of bedrooms ._'V. Number of baths V _ Lot size ------------------------------------- Water Supply: Public system ❑ Community system ❑ Private 00 Depth to Water Table 6.0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0� Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No IR New Construction: Yes [? No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S?ptic Tank: Distance from nearest wellld0 Distant from foundation r Mat ria)- ---------------••-. Distance ] No. of compartments__-. +_________________Size__ _! '�__ '�'__A�_•___Li Liquid de th_______ ___._Capacity/Z +Dd _ q P .. Disposal Field: Distance from nearest well./ -------Distance from foundation./..(Z:.---.......Distance to nearest lot line.. ...... Number of lines__________ _____ ______ __ Length of each line..../,#,)................Width of trench. ;0____. .'!__.•__-_______-__-.-- Type of filter mater4t-_ _Depth of filter material----. l(�':..........Total length---I&A_____________________________ Seepage Pit: Distance to n ar t II__ �_. ___ ist n .e nda�i istarrge to' earest of line_* �4_ V` 1W Number of PI --- ---------------- in ma erial _ ize. lam er-- Depth__- 3a��--------.-• A 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 lot line----------------------------- ----------------------------------------- ----•-•--------••------------------------------------•-------•-------- Remodeling and/or repairing (describe):--------------------------------- ----------------------------------------------------------------...--------------------------------•--•---•---- -------------------------------------------------------------------------- ---------------------------------------••----•-----------•-----••-----------•--------- -------•----------------------------------------------- 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 regula ons oZhn Joaquin Local Health District. (Signed)----- ---- ---------------------------------------------------------------------------(Owner and/or Contractor) By:............................-_--------------- ---•--------------------------------------------------------------------------(Title)---------------------.---------------_----. ------ � r (Plat 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--,- --- DATE.. -�3 Z---------------------------- REVIEWEDBY.............•-•----••-------------------------------------------------------------------------------------------------------- DATE-..----•.-------•----•-----•------------------------------- � BUILDINGPERMIT ISSUED------•----•------------------------......-------------------_•-•---------•------------ ............ DATE-------------___------------------------------------------ Alterations and/or recommendations-----------------------------------------------_-------------------------------------------------------------------------------.....---••--•------------------- --•----•-------- ---------- --------- -------------------------------------•----------------------------------------- ------------------------------------------------------------•---------------------------------------- FINAL INSPECTION BYA--- - 1------------------•---------------- Date.-•- -- -----•------------------------------•---••--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REVISED B•59 8M 5-61 ATLAS