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FOR OFFICE USE: .................. APPLICATION FnR SANITATION PERMIT Permit No. ..Z,.___.___ ------------------- .-- �"--- - - (Complete in Duplicate) Data Issued - -------------------------------------------------------- This Permit Expires 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 described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CAT ON '----- r-- ---- -- ---- •4! �` - . .....) Owner's Name !f• 1?� . " - ��---- -- Phone-------------------- Address------------------------ - Contractor's Name._._..----.. . -•----•• •------------------------------------- Phone..............---_-------------_ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ctel ❑ Other ❑ Number of living units: N er of bedroor,114R. Number of baths __Z_ Lot size .... . . ..........I......... - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy am [IClay Loam ElCny I-] Adobe ardpan F]Previous Application Made: '(if yes,date--------------------I No ew Construction: Yes to ❑ FHA/VA: Yes ❑ Noi[j__--` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest w ____� ___Distance from foundation_/�__�_.Mat riaf ___(,,ISr__.- �`r.fS�. No. of compartments--_. -----------------Size._. ----4Li uid de +h______:��.� Capacity q p Z.•r ---- Disposal d: Distance from nearest well__`-----Distance from foundation./.v__"".-....Distance to nearest lot4-11 /-- Number of lines-------------Z_----------------Length of each line....... -tt= idth of french----- Type of filter material._P_v `------Depth of filter material-./44-___-_-__Total length_____f _ --------------- ..s ______________ Seepage Distance to nearest well_____._....Distance from f�oun�dation. .o...�.....Distance to nearest lot line. .... Number of pits________ Lining material____: L�.C�1C�5ize: Diameter_____3__3�--------Depth------ c. ........... 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------------------------------------------ ClDistance to nearest lot line--------- ------ ----------- ------------------ ------------------------------------------------------------------------------------------•--- Remodeling and/or repairing (describe):--------------- ,�r�- ---- - --- ------------- ----- ......-................ ------ ------------------------------------------............_....----••------------------- --------------------- ------------------------1 ---------- -----------------------------------------------------------------------------------------------•-----------------------•--------------------••----------..----........---•------_ I - I hereby ce t ( have nare his application and that the work will be done in accordance with San Joaquin County ordinances, State ws, red rulestions of the San Joaquin Local Health District. (Signeii�d) _ ______________________ Owner and/or Contractor) t-------- - - - - - By:--------------------------------- -------------------------(Title)--- --------- (Plot plan, showing size of cation of system in relation to we Is, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---Al----.- - = ------------------------------------------------- DATE--------` �.�� °-------------- REVIEWEDBY-------------------------------------------- )----------------- ------ DATE------------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------•------------------------------------ DATE------••--------- ------ .----------------------- Alterations and/or recomTend'ations:. .____. -2 -- ------------- _---=-C _ 1----- --- - Z ....-----.- : '_ -__- - - ,.YLC _.-.-.,- 6`� ~------?......----- ------------- •--•-•-•-•-••---------- ------ t ---------------------L------------------------------ �-—:---------------- 1 f �'``°t -----°r`�L��```' ��1 * 1��1 f'`�/--`---sr�.�. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:- -/,/--- -•---------------- Date---.--` 1p / -------------------------------------------- SAN -j ----------•--•--------_-_----__.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 EB 9 REVISED B-59 2M 5-61 ATLAS 9