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FOR OFF CE USE: F- .. �� APPLICAMN AOR SANITATION PERMIT Permit Na. --- ....-•-f-•------ --------------------------------------------------------- (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 O dine o. 549 p JOB ADDRESS AND CATION_--•- J- •----------------------------------------- .....••--------.---.._..---- Owner's r Name------- -----.. Phone---------------------•-- Address. G - Contractor's Name.. ----------- -------- Phone...............................:. Installation will serve: Residence ga,'�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __ Nurflber of bedrooms -i2-__ Number of baths A-_- Lot size . llX._ $,f ............------------------ Water .... + Water Supply:" Public system Corfrnunity system ❑ Private ❑ Depth To Water Table .eft. Character of soil to a depth of 3 feet: Sand❑Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g?-Vardpan ❑ Previous Application Made:' (If yes,date_:;,_--_`---------- No ®-'New Construction. Yes Rj- No ❑ FHA/VA: Yes [lg—No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: l' (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) Septic Tank: Distance from nearest we[ ----------Distance from foundation_:_'� AP-------Material--- --------------------------------------------- I[�f� No. of compartments_____ __----------_------Size_e� ___ __5r!�/ ��Liquid depth____ r�-_/.______-_Capacity_.0--19 ______ Disposal Field:t Distance from nearest well __---------- istan�e from foundation-.__IgP_---:i Distance to nearest lot Number of lines---°.,t_______ Length of each line_.___ _ --- - g each �� -------------- �f -Width of trench -.r�_-o � Type of filter materialpDepth�ffiltel; material____�� ----- length_____ Seepage Pit: Distance to nearest well_. _.�_�.-_____Distant` ro 4-0 dation__•• _2-.___.D'stance to nearest lot line---1'�`�_--_ ®/ Number of pits___._/-__________._Lining material__ - f? .Size: Diameter__ �� p------.De th--o2s .._.. Cesspool: Distance from nearest well___ Distance rOmmkfoundatian '.____-:Lining material_______________ :-. -.. --------------------- ❑ Size: Diameter Depth.:.` -- Liquic! Capacity---------------------------- Privy: Distance from nearest well------_-------_--------------------_-------------Distance from nearest building-----_________________--_-_._____________. ❑ Distance to nearest lot line------------________'------------------------------ Remodeling and/or repairing (describe):-------------- (,f,?� r--------------------------------••---------------- t ------------------------------------------•---•---•------------•-•------------•-•-•--••---------------------------------------------------------•------•--....................................... ---------------•----------- - -- ........• -- -- - 1 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 and regulations of the San Joaquin Lecal Health District. (Signed)------------ ------A?V�_,�d�_—-=------- --------=------ ------ - - ----------------------------------- --161tumummwifor Contractorl By:----------------------------------------------------------.--•----------- ' ---------------------{Title)-------+t' .`------ (Plot plan, showing size of lot, location'of-syttehf i ' at ion to wells, buildings,-etc., can,be placod-on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----j ---- ------- - --••------- --- -------------------- DATE F `'' ------------ REVIEWEDBY---------------------- ---------------- ------------------------------------------------------------------------------ DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED-------------•--------------.------------------------------------------------------------------------- DATE----------------------------------------------------------- AFterations end/or racomm dations:_.-____._.___ __.__.___.4-------------- ----------------- ____.-_____ __ ---=--------------------------------------------------- ----------------------------------------------------- ------=------ ------------------------------------- `--•-•----._... --------------- -------------------------- --•-•----- ----------------------------------- - -. --- - -----------------------------------•-------- --------------------------- ------ ------ -------------------------------------------------------------------------------------------- ----------------------------------------------------- FINAL INSPECTION BY:----�� '----- ------------- Date------/- -------- --- �--~-----------��---------•------- SAN JOAQUIN LOCAL•HEAI_TH.DISTRICT , 130 South American Street 300 West Oak Street 124 Sycamore Stmt 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS '+5: :z