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FOR OFFICE.USE: IAPPLICATION FOR SANITATION PERMIT Permit No. --------------- ------ ---------------------- --- ---------------------- --------------------------------- (Complete in Duplicate) / Date Issued _----------------------- ------------------------------- This Permit Expires 1 Year From Date Issued i 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 LOCATION................. ` - - pp�Z// ---- -------•--- Phone.././ --- --i Owner's Name Address ._... ................... Contractor's Name--------------------------------------------- G - -----------•--•-•----------- Phone................................... Installation will serve: Residence J4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. .- - Number of bedrooms _-2,_-Number of baths .1...- Lot size ----------- __„x:..z. _ _ _""__..---..__ Water Supply: Public system W--community system ❑ Private ❑ Depth To Water Table -------- ft. Character of soil to a depth,00f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam B—Clay ❑ Adobe❑ Hardpan ❑ I Previous Application Made: (&yes,date--------------------) No E;---New Construction: Yes ❑ No [� FHA/VA: Yes ❑ NoL2— 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--_---._._-._...--_-----_----------.---------_--. No. of compartments ----------------------Size---------_------------...._Liquid depth------_-----------------Caaci Disposal Field: Distance from nearest well- •- :=_ Distance from foundation------!9,ry.._-Distance to nearest 1 ne_------ Number of lines------------------ -----Length of each line---..C/ --------Width of french----------- --- --------------- Type of filter material.-._ �__De th of filter material_-..e- - �� Total length___-_-_!_�?.v!------_-_I......... Seepage Pit: Distance to nearest well____________---------- Distance from foundation____--.-----__:::_..Distance to nearest lot line--.......--.----- ❑ Number"O""pits------------------------Lining material-----------------------Size: Diameter------------------------Depth------------------..------------. Cesspool: Distance from nearest ,Nell-----------------Distance from foundation--------------------Lining material---..-.__--_._-._-------------_--_-_- - ❑ Size: l7iameter = ` � .,;: ...Depth--------------------- -----------------------------Liquid Capacity-.------ •-------------gals. ._Distance from nearest building�. Privy: Distance from nearest well----=---------`""=d ---- -------- --- 9-----------------------....---------•---- ❑ Distancesto. nearest lot line---(?�±"-----•-----••--•-------------------------- -----•--------- --•-------- - _:::.. -------------•--- �. '� Remodeling and/or repairing (describe):_.. .._... _ __ a � '� `` _ �� yc ----------- - -- -" " "`"' ' ....----- ' .----------- �' _ ms's ''"� r � � h I hereby certify that I have prepared this application and thatFthe work will be done in accordance with $an Joaquin County ( ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. [ (Signed)----------------------- ----- ------------------------ ---------------------- -------- •-------------------------------------------------(Owner and/or Contractor) B . - -------'-------------------------(Title)--------- -------------------------_--- - - -.._._..--------- Y' �2-ems.......... ..:.. h (Plot plan, showing size of lot, location"ofsy in relation +o,.Wells,tbuildings, etc., can be placed on reverse side). FOR X2RTMENT USE ONLY APPLICATION ACCEPTED BY_----------- --- --------------- DATE----------- _11-------------------- . REVIEWED BY--------------------------------------------- ----=------------------------•------------------------ DATE------ -----------------------------------•-- BUILDINGPERMITISSUED---------------------------------------------------------------------------------•-------------------- DATE_.--------------------------------------------------------- Alterationsand/or recommendations:----------------- - ----- -•------------------•-•--•----------------••-•---------------------------------...----------------------------•------------------- _ -•-- --- ------ ------------------------------------------..--. ------------ --•-•--------- ----. ------- ------------------------- ------ ------------ ----------------------- -------------------------------------- -------------------------------------------------------------------------------------------------------- ----- ------------------------- -------- - ----- - ----------------------------------------------------------- ---------------------------------------------------------------------------------..------------_-------------------- FINAL INSPECTION BY:----- `',l.-.G --- ---- s Date.--- ^-+----- ---------------------------- I ,. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 124 Sycamore Street 205 West 91h Strut Stockton,California Lodi,California '° Manteca,California Tracy,California ES 9 REVISED S-59 2M 5-62 ATLAS