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FOR OFFICE USE: -------------------------------------------------------- - r. _______________________________________________________ APPLICATI0OR SANITATION PERMIT Permit No. _,�. ... .5 ------ (Complete in Duplicate) Date 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 AN LOCATION- _ -- .7" ---- ----------------------------- ---- MS`S ZO�?�6 --� t s� Owner's Name...--- ��" --------------- Phone--•--------------------------------- Address...............( •...- 1P -- ---------•- Contractor's Nam ----------------------------------------------------------------------------------------------------------------- Phone....------------------------------- -. Installation will serve: Residence T Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ---I---- Number of bedrooms _ ___ Number of baths _ _____ Lot size ----- - ! f Water Supply: Public system ❑ Community system ❑ Private a] Depth To Water Table _ Q_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam C@ Clay Loam ❑ Clay ❑ Adobe❑ rHardpan Lj, Previous Application Made: (if yes,date--------------------) No r� New Construction: Yes ® No ❑ FHA/VA:IYes ❑ No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: - ---(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material______-.-----__________-_--.---_-__._ `� ---------Capacity---•----�••.......1 , ❑ No. of compartments--------.•---------____--Size---------------------------------Liquid depth-.------------- - '� i N A. g '3' . - I`1�' Disposal Field- Distance from nearest well-. _ �. Distance from foundation__________ ------Distance to nearest lot line_______-•--_.-.. Q Number of lines---••------- - Length of each line---------� •----------------Width of trench.--�`�---- - ------......--- ! J Type of filter matenal�! _Depth of filter material___— ..........Total length- � "___�___________________ - Distance to nearest we€-17-4_-----------Distance from oundation__�a.---____--.Distance to nearest lot line-�-�-----.- ' Number of pits-----1--------------Lining material-- -Size: Diameter--.3.±._ ------------.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----------------------------------------- ElDistance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)---------------------------------- ------------------------------------------------•------------•----•-•--••----------•---••-----.._..------------------ ' --------------•----------------------------------••----•---•----------•----•------.•----------------------•------------------•-------•---------------.----••--------••-----•--------------------••---•------------------------ k 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 d regulations of t San Joa- in Local ealth District. (Signed) ' --- ------ ------ - --------------- •------------------(Owner and/or Contractor) BY= ----------------•-------------------------------------------(Title)----•----- ----------------------------- - - ------ ---- (Plot 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 �/ - -� ---------•------------------------- REVIEWEDBY--------------------------------------------- •-••----•--. DATE---------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------ •---------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:.----•---------------------•-----------------------------..........••---------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- --------•------•-•-----------------•------- ---------••-• ---•--•-- ------------------------------'•---------------------.-....----------------------•----------------------------------------------------------- FINAL INSPECTION BY:.. Date_-A/_.,_//p'_- --2............ 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 9 REVISED B-59 2M 5-62 ATLAS f