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FVK,UFFI E USE- ------------ 5--------------- -------------------.-_-------.-------- APPLICATION FOR SANITATION PERMIT Permit No. ,1 - --------------- -------------------- -------------------- (Complete in Duplicate) � // -------.--. This permit Expires 1 Year From Date Issued 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 AND LOCATION_.�11-- -_---J('/. G ----•------------------------- j Owner's Namer // --------- ------------------------- -------------------------------------------------------- Phone Address. -------------------------•-•------••-•-----------------------------------------------.._...---••--•---- -----------------•-------------------------- Contractor's Name--------- -•- --------------------••-•---------------•--.-•-------••---------•---------------•--..---- Phone................................... # Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. .._rNumber of bedrooms _-Z Number of baths ._/___ Lot size __.. xz-2l.• ____ ------r- --------------- Water Supply: Public system n___Commuriity system ❑ Private ❑ Depth To Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date.--------------------I No ET/ New Construction: Yes [B"'No ❑ FHA/VA: Yes ❑ No E�' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Distance from nearest well_________________Distance from foundation_______....._------Material---------------------------_..................... 7 No. of compartments--------------------------Size---_--------------------------Liquid depth-------------------- ----Capacity----------------------- Dis � istance from nearest well--- -------.-Distance from foundation_le. ........... to earest lot line^/......... PXX umber of lines------I___________________________Length of each line-..Z `___..._.__.._.__.Width of trench.rg_�`.....-..______________ Type of filter material.W44k----------Depth of filter material__f8:_u_________._Total length......'�__Q__-__--_•___________________ Seepage Pit: Distance to nearest well----_--------------Distanco �m foundation---ZQ_ _____.Distance to nearest lot line__------ \ ❑� Number of pifs-f/----------------Lining material..: .....Size: Diameter...r33``-_---___Depth___�s*---------------- Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material--------------._____-____________._._ ❑ Size: Diameter--------------------------------------Depth.---------------------------------------------------Liquid Capacity------------------------••-gals. . Privy: Distance from nearest well------------------------------------------------- from nearest building.__________-_-______._...-.-__--__-_--___. ❑ Distance to nearest lot line--------------------------------------------- - -•----------_------•--•------------------•------••------------- Remodeling and/or repairing (describe):-- ----------- - --------------------------------------------------------------------•------------•--•-•------------•---••----•---...--•-----•------- -----------------------------------------------------•------------------------------------------------------•----------------•------•------------------------------------------ -------•------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------------------------------------------.-----�osys+em --- --- ----- ------------------------------------------ ------------------- ------(Owner and/or Contractor) By:----------------------------••-------•••-•--• - -- - --------------------------------------------- ----------- -------(rifle)------ -------------------------------- --------- (Plot plan. showing size of lot, location in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - ------ DATE ... - REVIEWED BY----------------------------------------------- -- --------------------------------------------------------------------------- DATE..--- BUILDING PERMIT ISSUED._.. -------•----------- ------------ - - - ------------------------------------------------------ DATE------- ---------------------- Alterations and/or recommend bons-------------------- --------------- ----- --- - - ---------------------------------------------------------`----------- -------------------------- FINAL INSPECTION BY:---- �1-� 0'-_�J.A.. ------------ - Date-- .�3----4---r -------------------------- SAN JOAQUIN LOCAL•HEALTH DISTRICT 130 South American Street 300 West Oak Street 114 Sycamore Street 105 West 911%Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 zM 5-62 ATLAS r�