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FOR OFFICE SE: __---- -.------->f � � ,--'I-P' APPLICATION FOR SANITATION PERMIT Permit No. 1��---------------------- - -- ----- f.R-- (Complete in Duplicate) ---------------- This Permit Expires 1 Year From Date Issued Date Issued .._..._.1__C__P ._ 2✓ 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 o. 549. JOB ADDRESS AND LOC TION-- 244: ----------------------------------------------------------------------------•-••---......... Owner's Name.......... ------ Phone------------------ - - - --•---------------•-_•------------•-•-••--------- -----•- ................ Address - -------------------------------------------------- -•---•--•.. 4 Contractor's Name.................. y ------ Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l___ Number of bedrooms .__��____ Number of baths .�1.____ Lot size _______________•__.-____:-- Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g3-1lardpan ❑ Previous Application Made: (If yes,date____________________) No &'�'New Construction: Yes ❑ No R- FHA/VA. Yes ❑ 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 wel ________________Distance ro foundation----!�--------Mate ial___G !�d .._ _.._---------- No. of compartments_.__ .__`_____________Size_ � D`�Liquid depth....`. .�. . ____Capacity... _;0.4p..... ' Disposal Field: Distance from nearest well-.-"-.__:___._Distance from founclation___,�� ._...Distance to nearest lot line_e•►�_~-----•- ' Number of lines_______ _________ Length of each line_____ / "' t Width of trench ��------------=-- ='= I � � r---- -----��--pper� 9 � �+ � Type of filter materia k C�Depth of filter material___1AP_____.____Total length____---"W_ ________________________ —� � ~_ i t Seepage Pit: Distance to nearest well_____�"_�________Distance from foundation__--r.......Dis ance to nearest lot iine_� ------ Number of _____Numberof pits__..._______------Lining material_,.44�r�_ ______Size: Diameter_ - ----------Depth__ _ ........_________ d Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material_____._____.__-_____.__________-_-___ ❑ Size: Diameter----- --•--- ------Depth----•--•------------------------------------- ------Liquid Capacity---------------------------gals. LA Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.......................................... + ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------•--- •------••---..................-__— N. Remodeling and/or repairing (describe)----------------- -- --- _._._ / -- -- ------------------------------- ..` .. ----------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Si ned g )••-----•---••-----��--- -��----------�- --�-- ----------------- --- ----- ----------------------------------------------------(QwmgC:ffLdjor Contractor) ' ' SY ....................•-•-•------------------------------ -- -----------------••-{Title)-- -- --------- --------........---------------- (Plot plan, showing size of lot, location of syste n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----0--, ----7�0 ------------------------------------------------------------- DATE.....). -_I C —-------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------..._...-------.__-..-•-----------•------ BUILDING PERMIT ISSUED----------------------- --------------------------------•-----------------•-• DATE------------------------------------------------------------ i Alterations and/or reco mends ions•--------------------- -- _ _____-- .. -------- -- I -l `z- - - ------ _.. . --------------- fL. .-....C�.2......�._�� =.r`rn- a` ti .f1.,..1 .� -r... �'� t -------------- ----- - FINAL INSPECTION BY:._ .j.--- Date--- s��. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 206 West 9th Street Stocktonr California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-54 2M 5-62 ATLAS