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FOR OFFICE USE-. -------"-= ---------------------------" ------------ - "y' y APPLICATION FOR SANITATION PERMIT Permit Na. . >,JL /.. - ------ (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 Ofdinance No. S49. -��------6 �-.. -----•-----••---------------------------------------------------------- ---- JOB ADDRESS AND OCATION-___._ . - --"---'---------------------------------•- Owner's Name--- •. p ------------------ ------ Phone-- Address.-•--•......�� ... --•-------------•--•-------------------------• ---------------------•----------------------------------•- ..� + ---•-------. Phone.............-------__--------- Installation ..... Contractor's Name----------- - - --• ---- _..----•---_.-- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Z Ole Number of living units: __l_--- Number of bedrooms_ Number of baths I---- Lot size �-� ----------------•----------- Water Supply: Public system El Community system ��rivate I—] Depth TO Water Table 45—et, - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe erdpan ❑ Previous Application Made: (If yes,date--------------------) No Er-*'New Construction: Yes 9?-No ❑ FHA/VA: Yes [�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest ®� w � --._Dist�ana fr YYm foundation----/9......-Material---&� ':- V apacity-•-No. of compart -----------------SeLiquid dep`h_ ---------.-C Disposal Field: Distance from nearest well---------.-Distance from foundation.----�Q_-_-_..Distance to nearest lot _- ---- -- -------- Length of each line--- r_------------.Width of trench.- � --- _...--_-------.------- 11. >� Number of lines__Type of filter material�j ._ Depth of filter material._ /- .�� Total length/j V----- --------------------- D-st ce to nearest lot linel7�_---. Seepage it: Distance to nearest well-__ --__Distancdation___�----..�n i `� Number of its.---. ---Linin materia1.;-=-06n_Size: Diameter- - .----._.---__.Depth:-'&41<e P s2--------- 9 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 (describer _ � Lam / -----7 ----------•--------------•--------- ---.---•--- --•-----•---•--------------------------•---------------------------------••-------•--------------•----------------------------------------------------- ----.. 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 r es and regulations of the San Joaquin Local Health District. i (Signed) --------------------------(�or Contractor) By-------------------------------•-------------------------- ---- ------ (Ti+la)-- -�.--------------....------- --------- (Plot plan, showing size of lot, location of system ' elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED I •------------- DATE !� REVIEWEDBY--------------•---------------------------- --------------------------•------- DATE.--• -------------- BUILDINGPERMIT ISSUED------------------------------------------- — - ----------------•-. DATE------- -------- Alterations and/or recommendations: . Q,�>----- - / �9 --------------------------------------------------------------.------------------------------------------------------7r-----_----•-------••----------------------•---•-------•---•----•----------------*--•-----------------•- --------------------------------------•---------------•------------------------- -•-- --------•---------------------------------------------------------.-----------------------------------------..-----•------------_- --------------------------- -------------------------- - ----- --- --------- FINAL INSPECTION BY �� Date.- 'f - SAN JOAQUI OCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street, 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS