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FOROFFICE USE: --------------------------------------------------------- ----- ----------------------------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No./5... --------------------------------------------------------- (Complete in Duplicate) �` ---------------- This Permit Expires i Year From Date Issued Date Issued ..-.___--213 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d ribed. This application is made in compliance with County Ordinance No. 549. (}2S -1 I n WM>to J08 ADDRESS'A LOCATION' ..-. .......................... Owner's ° Owner's Nameee.. .. .. ..........-- - ----- - ------ ------------- ----------- �--` ------ Phone.................................... AddressI -� ------•----- --- -- ----31-7 `"�-- --"'-----------------------------.............................................................. Contractor's Nam ----------- ....... . _!S `� ......................................------ Phone................................... Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other E❑ Number of living units: ---)__ Number of bedrooms _- -_ Number f baths / ---- Lot size ___ _ �- _______ _________ Water Supply: Public system ❑ Community system ❑ Private De7clay Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ 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.)r Septic ank: Distance from nearest well---- Distance from fou dation----A-----------Material.---- ----- No. of compartments------7"""------------ Liquid depth------- -----------capacity_f-¢.G.l � Dispos ' Field: Distance from nearest well------5- -..._Distance from foundation.. ... ..1___Distance to nearest lot l e¢, "...*.... Number of lines----••--- ----------------- ----Length of each line--------g �_----'-.Width of french------- ..------ ---------------- Type of filter material.._ -_Depth of filter material....../_ �--.--Total length-_.__f,4............................. C Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---_----_--._--.- ❑ 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--------_-._---.-_--.--___--_-.--.-------. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------_--------------------••----•-------------- Remodelingand/or repairing (describe):------- --------------------••-------------•--•-------------------------•-----•----------------- --------•-•----------------------•---------------------- -----•-------- 1 I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat . aws,C nd rules an regu tions of the Sn Joaquin Local Health District. (Signed) - ----------------- - -------------------- -------------------------- ---------- ---------------------- r Contractor) BY= ------- t ��6-_=iing,. - (Title)-------------------- --•------------•--------- `--------- (Plot plan, showing size of lot, location of system in ation to wA slr etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 10 APPLICATION ACCEPTED BY-/,*---- - _- - ----------------------- ---•----.. _---------------------_-- DATE--- REVIEWEDBY------------------------------------------------------------------------------------•---------------------------------------- DATE----------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------- -------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:---------------------------- -------------------------------------------••---.-....-..------•-------------•-----------•---•-------------•---------------------- -----------------••- ---------------------------------------...---•-••-------------- -------------------------------------------------------------.------------------------------------------------•-•----------------------- -•------•-------------•-------.--- ----------------------------------- •----- ----------------------•---•----------•-••----------------------------•-------•------------------------------------- ----•--------------- FINAL INSPECTION BY:....... Date-•--°2 .,�/f/, + -&•3 �- -------------------------- - -- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 Wast 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 13-59 2M 5-62 ATLAS