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I-UKU!-FICE SE: ------ - fo•2 ---- - - - ------- -- --------•---- a,. ------------ '37 APPLICATION FOR SANITATION PERMIT Permit No. -- ------------------------------------------------------ (Complete in Duplicate} "----------------- ---- This Permit E ' Date Issued --- ��r� .Z x Pfires 1 Year From Date Issued --- lig 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. 54 JOB ADDRESS AND LOCATI N_..__• --•-•-------------------------••-••. Owner's Name sF l/' f - -------...............•------------------------- Phone.................. Contractor's Name_____________ •------------ --•-------.....----- ---•---•------••-•-•-•-•.................... - - -------------------- - Phone Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: -/__- Number of bedrooms ;?-- Number of baths ./--. Lot size -----_--- _---------- Water Supply: Public system �KEomrnunity system ❑ Private ❑ Depth to Water Table .,,Qtt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date___________________) No gj-�New Construction: Yes ❑ No Rjo1'01FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: P (No septic tank or cesspool permitted if public sewer is available within 200 feat.) Septic Tank: 0 Distance from nearest well_________________Distance from foundation------------------- • � �'d 0 /� No. of compartments_; ------•-----.._S••Ize__....----•--- •------.Liquid depth------- ----Capacity Disposal Field: Distance from nearest 'well------- --•_Distance from foundation---/`.Sr4'_--------Distance to nearest lob Number of lines___________ __ Length of each line_____ _ Width of trench-a -_- ,_ YPJi - ---••----•------••- Type of filter material. - Depth of filter material -------.-.Total length.___.. t" -�-------------•-___•-_-_- S page Pit; Distance to nearest well_-___.mss -------Distance afro fou ation.._IA-9 ...D's�ance to nearest lot line__.��_.._ Number of pits..-_../_.--___-____Lining material'.�O Size: Diameter__ ---- / • =-=- -----Depth:'".----•--•---------- � 1 Cesspool: Distance from nearest well_________________Distance from foundation----------.---------Lining material_---_--�•-----------------•-•---_--•-- ❑ Size: Diameter--------------------------------------Depth------. - Liquid Capacity gals. ----- Privy: Distance from nearest well___ ______________________��.__-_..._-Distance from nearest building ------------------------------------ ----------- I Distance to nearest lot line--------------- ----- , ----- •----••------- Remodeling and/or repairing (describe)_______________________ fir • --- - ------------ -------------------------- f - ___________________________ ___------_..................--------------------------- -------------------------------------------------------------.-...............---------------------------------....------------------------_..__..__.....____•__...__. ..�__.__._....__.-------------------------------- 1 k I 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 a d regulations of the San Joaquin Local Health District. ,- (Signed) =--r-•-----•--------- a� ---- ---- ----- ------ ----- ------------------------�r Contractor) By:-----------...................................... --------------..(Title)--- ------------ (Plot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse ide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ REVIEWED BY. „` - DATE - ---- . ----------------------------------------- --- DATE-------•----------...-•-------••-•-••--•-•---•----••----- BUILDING PERMIT ISSUED_ ._...------•-•---- ... -- Alterations and/or recommendationsi.- ./, :-- A TE - --- - ---- FINAL INSPECTION BY-- .... ------- Date......=.:Z-/._ ----------------------- -----•----- -----------•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street + 1 t " 144 Sycamore Streef 205 West 9th Street •, Stockton,California 'Lodi,California Martleca,California a Tracy,Collfornia ES 9 REVISED E-59 2M 5-61 ATLAS