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FOR OFFICE US : rf�Z 3.3 46. - ------ ------- / V-) -7.. � �iPPLICATION FOR SANITATION PERMIT Permit No. .. .__ _ ----------------------------- --------------- (Complete in Duplicate) /Cf / Date Issued ___. ------------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN CATION -----------/4� ------------ ------/ G PSS / Owner'sm �/ 14 = ------ Phone------------------------------------- Name- ------- -- -_--•---------------------------- �w/- -- � .................................. Address-•••--------•---•------------------------- Phone ----------- Contractor's Name------------------ Installaton f will serve: Residence/[g/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other El of living units: _1.--- Number of bedrooms --Number of baths /_-__ Lot size . ---X-111------•-------------•••--------- -- Water Supply: Public system ,[Community system ❑ Private ❑ Depth To Water Table eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,Hardpan ❑ d Previous Application Made: (If yes,date--->------------------) No [D.-'New Construction: Yes ®"`N-o ❑ FHA/VA: Yes ❑ No ®-_� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s �Q f M t dal__-d_d_AS.l'',f-C Septic T Distance from nearest well__ istance from foundation___ _______________ No. of compartments----- --------------Size_. _. _cf� __.---Liquid depi�_.__7-/�--------- Capacity--.. --••--- Of Disposal ield: Distance from nearest welly'' "..-.Distance from foundation....ZI?........Distance to nearest of line,, - Number of line's-------------I/ ;__--_._____._._Length of each line_-.--____�_ Width of trench...... ------------------- 01. Type of filter material._._f' :_ 5--kDepth of filter material---1_ !------------.Total length-_...-.--�®f......... ------------ Seepog PDistance to nearest `Fell------ '____Distance from foundation___,/-_-�._---Distance to nearest lot line...s`?.r. Number of pits________1..__-____.__Lining material.. �-iir------Size: Diameter--33_1_.......Depth---G?9Lr-.j•--••-•--------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------- material..----------------------------------- rr A� i Size: Diameter------------------------ •-----Depth-------------------•--------------------------------Liquid Capacity-----------.----------------gals, V ' I Privy: Distance from nearest well---------------__.---_--..----------'--_._--.-Distance from nearest building------------------------------------------ ElDistance to nearest lot line----------------------------- --------....-•-------------------------•--------•---------------------------------- Remodeling and/or repairing (describe-------------- .�� ---•---•----•---- ------•-•----.---- - ------------•-----------------••------... .... - ----------------- ----------------------------------------•-- - •- ---- --------------------------•---------------....--------•---------1---------- ------ ----------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County V ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. Si "ad) --- - �----- G------ - ------ -------------------•--------------------------------------•- {Owner and/or Contractor) f'C - - ----- •-•----------------•-(Title)------a4revers�e --- = (Plot plan, showing of tot, ocation of system in relation to we ings, etc., can be plac FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ..... s--------------------------------------------•---------------- ---- DATE_.k:7?�n,!_';!--- Zr REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE.------•----------------•----------------------------------- BUILDINGPERMIT ISSUED---------------------- •------------ -----------•---- DA-TE------------------------------------------------------------ Alterations and/or recommence tions(---------- •----------r t ' -- ---- -- -- ---.-.--.---------------•-•-----------•-- - ---------------------------- FINAL INSPECTION BY:....-j`�----- - -- - ----- - Date----1 fSAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California TraCyr California E5 9 REVISED 8-59 2M 5-62 ATLAS f