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FOROFFICE USE: ----------------------------------- --------------------- -- -- y �- - APPLICATION FOR SANITATION PERMIT Permit No. .. . .... --------- -------------- ------ �1----.. "" "" (Complete in Duplicate) ------------------------------------ --------------------- This Permit Ex fres 1 Year From Date issued Date Issued .�..._..�•��- Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI N._k"2�-)'Owner's Name_ --------•-----•----------•------------------------ ----- Address__._.._ --.. Phone_. ---------------------- = �` Contractor's Name------ -- •-- ____ ____ ----•-...__ Phone............. Ins+allation will serve: Residence Apartment House ❑ Commercial Number of livingunits: . ❑ Trailer Court ❑ Motel ❑ Other ❑ /--- Number of bedrooms ,Z-. Number of baths ._1__ Lot size _.____ Moor— Water Supply: Publics stem g --------••------ Y ❑ Community system ❑ Private [Depth To Water Table f ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ®Clay ❑ Adobe Hardpan Previous Application Made: {If yes ❑ Eldate____-__.__._-"-__.) No � New Construction: Yes F] No ®�'FHq/VA: Yes [3 No R_ --- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:r ;EP Distance-from nearest'well-----------------Distance from foundation-_____.__..___.____.Material_.__.-"__"" "--"" ��L� No. of compartments-----------------------.._Size._ -----•......---•-----•----- p ------Liquid depth-------------- Capacity Disposal Field: Distance from nearest well.._?Q ---Distance from foundation__ Number of lines.___.__.I". �l� ------Distance to nearest ft line. r --..... {1.� ` r -------- Length of each line.--- __ -. - Width of trench_-_." -"-_�- ti" Type of filter material a pp //" •"/LSM__Depth of filter material__._ -----Total length__.___ Seepage Pit: Distance to nearest yrelL_ �f "� '� Distance from fo dation__-./A0_ •.Distant, to nearest lot fine_.. Number of pits_ ___________Lining material__,t' j� _Size: Diameter___" Cesspool: � - --------------Depth__/�----••--•-----• , P Distance from nearest well-----------------Distance from foundation"---___.__-___, U Lining material ----•---•------- .- •------•--- I Size: Diameter--------------------"_ "-- _ _ -- -----------Depth----------------------------- -------- -------------Liquid Capacity Privy: Distance from nearest welt------------- --- " q -------•----•-' -------gals. ------------------------___Distance from nearest buildingcQ ❑ Distance to nearest lot line__--------.""-""_- -"_- -------"--.".. .� ----•--------•-----•--•----•---------- Remodeling and/or repairing (describe}: Z� _ •-----••----•---••---•----•--••-•-----•--- •----•------•----.---•• t ----------------- .-•--- 1 e - • -- - I - e - -- ---------------•---------•-----------------•----•--•-------------------•--------------------------•---------•----- 1 hereby certify that l have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, State laws, d rules and re-KlaT' s of the San Joaquin Local Health District.5i ned / v9 ) le-- - ------------------ -- -- --------------------------------------[I9;X1;Xa;;;1l?!0r-=-----------------•-•--•--••--•----- r ontract or) --------------{r+le) � (Plot plan, showing size of lot, location of system in rn to wells, buildings, efc., can be placed on reverse side). R FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-" --------------- 1 6 REVIEWED BY �Ci DATE---------- ---- 11 BUILDING PERMIT ISSUED_.. --•------------------------------------------------• ---- ---.-.----• ------------•- DATE•------------ A erations and/or recommendations:_____.__."-_.__ -------------------------- ---------••--.----- •--------••-------•-----•--------------•-----------------••------•--.--- •-------••-------------- --•-----•--•---------"--------•-----•---"-------•--------•--•----•---------------------------------------------------. f ----------------------------------------------- I ------ -- •--•-- ------•------•--------- . - ----------------------- -- --. --------- .- d ---------- 10 AL INSPECTION BY:........... - -----� ------ --- - Date-------------- . ._..� �. . ------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT z 130 South American Street 300 Wept Oak Street �: ti t 44 Sycamore Street $05 West 9th Street Stockton,California 300 California `�- Manteca,California Tracy,California ES 9 REVISED B-59 2M 9-62 ATLAS