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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i Permit No. ` _ .!... f V*----------------------------------- ---------- (Complete in Duplicate) — L 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 Ordinanc No. 549. I � JOB ADDRESSAND LO T N 0.. l/1J =----------------------=-----------------------•----------------...............--------- Owner's Name --------- ----------------------•---------------•-----------•------------------ Phone. Address -------------------------•------------------- Contractor's Name.-- -- -•-------- - •--••• Phone..............-.......... Installation will serve: Residence RKApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' � ,yam/ Number of living units: ___�__ Number of bedrooms _ _ Number-of baths _,l.:Lot size 4'.p_X4 -•-•••.----•--------••••-•-•-••..... Water Supply: Public system [[, Community system ❑ Private ❑ Depth To W' ate'r Table _ eft. Character of soil to a depth of,3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M---Hardpan ❑ Previous Application Made: (If yes,date-----------_--------) No New Construction: Yes ❑ No R],'*�FHA/VA: Yes ❑ No 9�— TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 fee#:) -$` Septic ankkT 1 Distance from nearest well_______________:Distance from foundation.................. Material------------------------------------------------- 04 No, of compartments- --._ - Size-----•-------------------------Liquid depth................. --------Capacity-------------------- ._. %, Disposal Field- Distance from nearest well----- ''.._.Distance from foundation _._._-Distance to nearest lot line................ Number of. lines---------- -Length of each line..... 90-!_______N..Width of trench---A-_________________________ Type of filter material ;depth of filter material.---. 7//-----Total length-----A --_--------•--••- Seeage it: Distance to nearest.well_____________________Distance fr fo dation-...._j;f1- __.D-sfarce to nearest lot line��..._ Number of pits------/-------------Lining material.... -Size: Diameter_ ••_-._..----Depth__.r,V _____----..._.. - Cesspool: Distance from nearest well-----------------Distance from foundation---.-----------------Lining material---------'."'------------------------- ❑ Size: Diameter--------------------------------------Depth----•---------------------------------------------.Liquid Capac ty__=�---------------------gals. Privy: Distance from nearest well-----------------------------------------_--------Distance from nearest building-----------..--._--_._--.-.___-________._. ❑ Distance to nearest lot line----------------------------- -- ---- --------------------------------_;----------------------------------------------•-------------- Remodeling and/or repairing (describe):---------------------- ________ ---�{ '�' .....--••--.----------------------------------------------------------...---- •- ,. --•-----------•--- -•--------•------------------------------------------------------------ 1. ------•---------------•-------•------- ..............................---------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------= 5 -------------------------------------- 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 ales and rega�fiio,s of the San Joaquin Local Health District. W7 (Signed)---------------------a-- -- -- - ------- --- -------------------------------------------------------------�/or Contractor) BY=--------------------------------------------------•-...... --- --- ----- -----------------------------(Title)--•• f/!"� ------------ ----------------- (Plot plan, showing size of lot, location of syst to relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.._L_ .__-__._____ �s -�._. -________________________ ... . .---- -- ----•---- DATE.... .-�-7--�--1�7-- •�-------------------- REVIEWEDBY-------------------------------- --------------------------------------------------------------•......... DATE---------- •---------•-----------•-----•------------------- BUILDING PERMIT ISSUED----- --------------------------------------------------------—...................................... DATE-------------------- ------------•--------- ---••---•- Alterations and/or recommen a#ions: ---------------- �S-7.-.. . _.. �- --�, ---------------- - --------------- ....__._ -----------------------------------------------•--- -----------------------------------------------------------------._... --------.-....................--------------------------------------------------------- •------ 1 FINAL INSPECTION BY:------��. __.,--• JAN Date------------ -- - --------------------- 4 JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street e � 124 Syciamore Street 205 West 9th Street Stocktonr California Lod[,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS