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FOR OFFICE USE: -a ------------------------------------ -------- APPLICATION tFOR SANITATION PERMIT Permit No. 1-f �- - --------------------------------------------------- -- (Complete in Duplicate) 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 Ordinance No. 549. tJZ3—cs3tJ—r7 JOB ADDRESS AND LOCATION..11 Pt •� fiG-m<sJ'...-M................---.... . ..................... ------ Owner's Name----- Phone-----•------------------------------ Address-_.......... ••--•-----� -•---•---------•------------•-------------•--- Contractor's Name-- R-------------------- - ------ --- -- ------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial❑Trailer Court El Motel ❑ Other ] Number of living units: -------- Number of bedrooms -------- Number of_CVAs JY_ Lot size . ------------------------•-_-_-..____..._..-----_ Water Supply: Public system ❑ Community system ❑ Private [�] Depth To Water Table .R-P. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [fl Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date--------------------) No 20 New Construction: Yespp No ❑ FHA/VA. Yes ❑ No [ og TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ff1' Septic Tank: Distance from nearest well--crD---------Distance from foundation--11!-------------Material--- .......................... ?] No. of compartments---Z------------...... aC.....Liquid depth--....-.----------------Capacity....................... f4d Disposal Distance from nearest well.�a--------.-Distance from foundation...19_--- ....-.Distance to nearest lot line...s.......... 93 Number of lines-------1-....--.--_----------------Length of each line---Jk.6k8_-------------Width of trench.----_-----_----.__---_.-----_-.• Type of filter materialsAm s_ -------Depth of filter material-----G _}6 k ---------------Total length____ ---F----------------- - Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-------------- ❑ Number of pits----------------------Lining material----------------------.Size: Diameter----.------------------Dept h---------------------•----------\� Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material..-.---.-_--.-..-.-.-_............... ❑ Size: Diameter--------•-----------------------------Depth----------------------------------------------------Liquid Capacity............................gal` Privy; Distance from nearest well------------------------------------------------Distance from nearest building----_---_--____-----_-•---•-_---_--------. ❑ Distance to nearest lot line----------------------------------------------------------............-•-•-----•-----•------------------------------------------------------ Remgdelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------ ------------------•-----•-•-••-------------------------------------------•---------•----•------------------------------------------------------------ •----------------------------------•- ------------------------ ------------------------------------------------------------I•--------------------•------------------------------------------------------------------------------------------------------------------------------- --------- I hereby certify that € 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. 5i ned ._.-. ------------- ------ -------------------- ---- -- -----•------------------ Owner and/or Contractor By:--- q,4�_. : . ............... (Title)-------------------------------------------- (Plot plan, showing size of lot, to than system in relation to wells, buildings, etc., can be placed on reverse side). ~ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY, ------------------------------------------------------------- DATE..--`�-Z f�-��--------------------------------- , REVIEWEDBY--------------------------------------------- --- -------------------------------------------------------------------------- DATE--------------------------------------------------•------- BUILDINGPERMIT ISSUED--------------------- ------•---------------------------------------------------------------------- DATE------------------------------------------------------------- Alferafionsand/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------- ----•-------------- -----------•-••---•-------•--------------------------••--------------------------•-------•--------------------•---•-•-•---•----------------------------------------------•--------•----------------------•-------------- ------------------- --------------- ----------------------------- --- -----------------------------------------------------------------------------------------------------------------------------------.•------ FINAL INSPECTION BY:.....!1-. !' n't. ---_ .-. - ��" - Date---- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Woof Oak Street 124 Sycamore Strout 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 11-59 211 5-62 ATLAS � w