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FOR OFFICE USE: 3 ,57 ------------- ------------------------------------------ APPLICATION FOR'SANITATION PERMIT Permit No. -----------•-- ------ (Complete in Duplicate) d Date issued _.. '+ ------------------ --- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit tgonstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 8 1y i I, JOB ADDRESS ANTION... -----------------------------•-----------------------. - Owner's Name-------- � Phone.. ---- .. %Address----•--------••- ----- -------------------------------------------•----------------- Contractor's Name.....•. -- --- ------------- -VD h—, -----------------------------------------------------------------------•----- Phone-_............................... Installation will serve: Residence n'-`X,partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1'Number of living units: ____1_ Number of bedrooms___. Number of baths -1. Lot size _---------------------------------------------------________ Water Supply: Public system U>6ammunity system ❑ Private ❑ Depth To Water Tablet ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand am E] Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: (if yes,date--------_----------I No New Construction: Yes No ❑ FHA/VA: Yes ❑ No Q� f 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 -�___Distance from fou dation-.r________________.Mateyigl_____ __------------------- __...._... [j/^ No. of compartments_.-__ ____-______Size.___ _ f ...Liquid depth_.......____/ ____Capacity.. _____.. Disposal Field: Distance from nearest well-_---Distance from foundation./e__�._...Distance to nearest t �ne��7 .... Number of lines__.__._.._. Length of each line-- Type ine__ _ !______.Width of trench .. ..) T e of filter materialr. Df_C IIDe Depth of filter materlal_._ _ :___._Total length __S� _____________ p yP p g _ Seepage P• . Distance to nearest ellr` '__Distance from foundation..�_d�___..Distance to nearest lot line_t57 '___ ❑i Number of pits----------------------Lining material.__ -,_Size: Dia meter__ _.____.Depth_____-.______________ Cesspool: Distance from nearest well------------------Distance from foundation.-------------------Lining material___--_-______--_--_-___._____________ ❑; Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals . Privy:i Distance from nearest well-------------___---------------------------------Distance from nearest building_______._-____-__-----_--___-__--____-_. ❑ Distance to nearest lot line------------------------------------ ----------------•-----------------•-------•------------------------------------------------------------ --- •-----•----------------------------•-•----•---------------- Remodeling and/or repairing (describe):------------- � - ------ K ----------------- -----------------------------------------•---------. -. -----•-••--•-----------•---•-----------•-- ------------------------------------------------------------•--•..------------------------------------- -----------------------------------------------------------:, IIhereby -arti t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State , and rules gulations of the San Joaquin Local Health District. ------- -------- ---------- ------------------•------------------ ----- ----__.(Owner and or ontractor (Signed)---•-- / ) BY; ... ---=---------------------------------(Title) -•----------- -- -- ------ -------------- (Plat plan, showing size of lot oc ion of system in relation wells, buildings, etc., can be placed an reverse side). FOR DEPART ENT USE ONLYof / APPLICATION ACCEPTED Y -- -- ------------•---------------- DATE-•-f- -- REVIEWEDBY--------•--------------------•--------------- ------------------------- ----------------------------- DATE---------- ---- --------..._..---------•------------- 13UILDING PERMIT ISSUED.._.._.. - ------ ----------------------------------- --- Alterations _ -----------------------------------------------------------------------------------------------------------------------...-•......................................................................... ---------- -----------•----•--------------------------•-------•-----------------------------------------------------------------------------•-----•------------------------------------------------------------------------- •------- -------------------- --------------------------------------------------------------------- ----------------------------------------- . .-- ----- Date----- ._ ; 1=IN�AL INSPECTION B •..-------- ----- -- -- - - .... ... -- -- - .... .- ---- ---�----------••--- SAN JOAQ LOC HEALTH DISTRICT Iti '130 South American Strut 300 Wed Oak Street 124 Sycamore Street 405 West 9th Street ` Stockton,California Lodi,California Manteca,California Tracy,California " . a E5 9 REVISED 9-59 2M 5-62 ATLAS f�• - I