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u�� 5 •ter—�11.L�-.. --�_._. FOR OFFI U E: / ` q APPLICATION FOR SANITATION PERMIT " erml -------------------------------------------------------- (Complete in Duplicate) ) � Date Issued --- ThisExpires -(p-/�•--G-- Permit Ex ires 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 descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATION.. --- -----------------•--------------- ---- Owner's Name------------ ------ Phone----------------_-----------••--- dAddress ................. --------------•-------------------••-•-----------•--•-----•-....................... Name-------- - ------------------------------------ ----------- Installation Phone----------------------------------- Contractor's Installation will serve: Residence impartment House ❑ Commercial ❑ Trailer/Court—E], Motel ❑ Other ❑ Number of living units: __ :_ Number of�bQdrooms , __. Number of baths J---- Lot size __ t- -_-------•-•------•-•----•-- Water Supply: Public system ❑ Community system �rivate 0 Depth To Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel [3Sandy Loam ElClay Loam ❑ Clay ❑ Adobeiardpcn ❑ Previous Application Made: (If yes,date-------------- ---- No New Construct ion: Yes .9111�o ❑ f FHA/VA: Yes R —No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �ld n " et(No septic +elk or cesspool permitted if Publc sewer is available wit i . e . I m foundation -------- MDistance from nearest w DSe ficT 01 � � t f; � actySizeLiquid depth----- � p �G�_ � No. of cam artme -----------..-.. !� = - �` Disposal r < . sn > _._-.-.-.- .ll = tNumberr of linesLegh of each I line `-.---�----.--WidfK,of trench...r'1____________________________ Type of filter mate Depth of filter materlaL_ __...--Tot�lr'length__- -�.•------------------ r -- Seepage Pit: Distance to.nearest well-----_. ------Distance from foundation----/ .f....D istance to nearest lot linea ______._ ®/ Number o P, 01,452 material_,Q --Size: Diameter -------_.:Depth- �'.-....---------- - Cesspool: Distance from nearest Well .......... _......Distance from foundation--------------------Lining material----.....-..__.---_____....---------- ❑ --Liquid Capacity------------•---------------gals. ` Size: Diameter____-------�--------- ---------•-----Depth--=----------- -------------- --------------- - l IPrivy: Distance from nearest well__________________________ ----__:--_=--Distance from-near0s building----------------------------------------- ❑ . Distance to nearest lot line ----------------------------------- --------------- Remodeling and/or repairing (describe):----------- /"aW� - --•--••---•--•---••--------------------•-•--------•--------.----------------------------•---------- -------- -----------•--- ------------------------------------....------------------------------- .. ��._ _L __, ,»-. = ----------- ---------------------------------------------------. ---------•-••----------------•--------•------•--------------•-----•- -------------------------_ ------------------•-••-----------------•-------• ---------------------------------------------- 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 and regulations of the San'Joaquin Local Health District, /or Contractor) (Signed)- ~ -------------- ! BY: 3 f---------(Title)--- V41W ••----------- (Plo+ plan. showing size of lot, location of.system-in-r tion-to.w.ells,..buildingsr.etc., can be placed on reverse side). FOR PARTMENT USE ONLY.,...:=-- - - ------ APPLICATION ACCEPTED SY__ ------------•-•-----------• DAT REVIEWEDBY------------------------------- -- ---•-••------•------ DATE----- -... BUILDING PERMIT ISSUED---------- -- •--- - �— ------ •---- ------------------••-----------------••------------------- Alterations and/or recommendations: ----------------------------- ------------ ---------------•--------------------------------------•--------------------•------------- .-_ ---------- ---••------ • .--.-----•...................... . .... ..... . .. ... ---------- --- ----- - ----------------- --------------------------............... .--.--••-•--------------------------------- / .. . FINAL INSPECTION BY1---.... •- ----- ---- - ..... ------ Date__------------- .... . ..... ----------•-----------------_- SAN J QUIN L AL HEALTH DISTRI 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS