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FOR OFFICE USE: k ---'--� '— --- ©----------------- ---- Perm+t No. .... --------------- -----------_- APPLICATION FOR SANITATION PERMIT �' (Complete in Duplicate) _..._. -------- Date Issued .s._•�---!�� ----------------------------------------- This Permit Expires { Year From Date Issued Application is hereby,made to the San Joaquin Local Health District for a permit to c4 r d install the work herein described. This application is mode in compliance h County Ordinance No. 549. JOB ADDRESS,AND LO N _ _-�. _. ____� -__---- "�`!-•---------- ry� y .. _ - --•--- -- Phone.----••-----•-----•---••--••---... Owners Name :-------.--k 1412 ----. _`.. -- -- --•------------------- --- ------- Address--- ----••----•-•------- ------ ---------.... -- -- _ =a ~-:.._ ------ ---------------------------- ---- = ... Contractor's Name------- Phone--------------------------•• --------------------------- Installbtion will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: __r..-. ber of bedrooms--- Number of baths ._-�.- Lot size ...........:................................................ Water Supply: Public system Community system 4❑ Private ❑ Depth TO Water Tableft. Character of soil +o a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam��No lay ❑ Adob Hardpan ❑ Previous Application Made: (If yes,date-----_-------------), No New Construction: Yes ❑ FHA/VA. Yes ❑ NoiL TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet) • v = C C3 r1c.x - Septic Tank: Distance from-nearest well--- _-Distance from-foundation-- ------------.Ma egal-------C------__-...._-. .... 4 E 40 E?" No. of compartments.---- �----.----.-Size..s�r _ ---i-.Liquid depth__.._y__-/ �______FCapacity... Disposal eld: Distance from nearest well. ^._Distance^'from foundation=.. ©._r�istance to nearest lot lines JF ©/ Number of lines------------ Length of each line_- . 'sf_ ,.�--_.Width of trench _._W9---------------•--- Type of filter material. 1a..__r_Aj-_ Depth of filter material'-.� _�_- -•----------------•-- Seep g it: Distance to nearest well---- ''_--Distance from foundation/0 Distance to nearest lot line f_._ •. Number of pits-------- material-:-��-�-Size: DiameterK�_�------Depth-- 1--------------- Cesspool: Distance from nearest well-----------------Distance from.,.foundation-- -----------------Lining`material-.---_------.--._--------------------------------------- ❑ Size: Diameter--------------------------------------Depth--------------------------------------------'- Liquid Capacity.. gals. 4 Privy: Distance from nearest well--------------------------------------------------Distance from nearest building----.---_-._---.-__-_____-.-.------------- ❑ Distance to nearest lot line-------------------•--------------------------------------------------------------------•--i------------•-----•----------------------------- Remodeling and/or repairing (describe):------------- . ..... --- ----- ---------- ----- •---------•---•-...------------------------- -----•-----••---------------------------•----------------------•------- - . -------- ----------_-------•------- 9 ----------------------------------------------------------------------------------------------- '- ' I --------------------------------------------------------,---------------------------..-----------•--------•---_...-----'-_.-�£'----•-•---------••-•---------_--.-----------�-------------•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordsce with San Joaquin County ordinances, Stak laws, an and regulations of the San Joaquin Local Health District. (Signed)------------- -��--•-- ---------- �--------- ---------- --------- - --------------------------------------------•-----•-------- (Owner and/or Contractor) 14 ----------- By:-_---------------- (Title}. ----- ------------ ---- --------- (Plot plan, showing size o lot location of system in relation to we s, buildings, etc., can be placed o n reverse side}. i 'OR DEPART NT USE ONLY I ' APPLICATION ACCEPTED -- - -- ----------------------- DATE- ' ' - --------- ------- = = ---••------------------------ DATE-------..g....--1�_____----•----•----------------------- REVIEWED BY------------------------------••--•--------- .. BUILDING PERMIT ISSUED-----------------•------------------- ----. ._... "� -f { ` Alterations and/or recommends+'8 is*------ -�. . -------- -------------------------••- ------------------------------------ ------ ---------------------- ----------------------- ------------------•- --------------------------- FINAL INSP TION BY:`---- - --- ---- ---- - ------ -- ----- --- • Date.----�--- --- - --- - ---------- ------------ � - ---- - ` SAN JOA UIN LOCA EALTH DISTRICT 130 South American Street 300 West Oa STreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Cal farnia Manteca,California Tracy,California ES 9 REVISED 6.59 2M 5-62 ATLAS