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FOR OFFICE USE: t .. ...G�f- --------- __ _._ . APPLICATION FOR SANITATION PERMIT Permit No. ---------- ---------------------------------------------- (Complete in Duplicate) Date Issued -------------- I 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.her in described. This application is made in compliance with County Ordinance No. 549, t�ae.i_s��;,_ -c t� dxi,�.-�- -� $ JOB ADDRESS AND LOCATIONX.,,4--3--------- ......... T/kn/------------------It ---------------.................................................. on�Q c y.................. S Owner's Name ----- Ph Address Q . -•-- ------- _ Contractor's Name----- P `- -±»'` Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ./----- Number of bedrooms .-'2:Number of baths ----L Lot size ............................ Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table .�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Q' Clay ❑ Adobe[Hardpan ❑ Previous Application Made: 1lf yes,date---_---- .......1 No New Construction: Yes [vallo ❑ FHA/VA: Yes ❑ No Q-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_--57a.....Distan a from foundation---Id" -------Material..._ elp...! .............. No. of compartments......-2.............Size x__'�?� .?Xf____Liquid depth--- -'.-----.....Capacity/g ....... ' Disposal Field: Distance from nearest well__,5_-0.'.:_Distance from foundation....../d_.'_ .-Distance to nearest lot line....... ... y... [� Number of lines-----.__.f------------------------Length of each line............. ----- ..Width of french-----------Z.5_'•--------__ Type of filter material.:i�O_(__/e--------Depth of filter material------?�1}}...........Total length................... o`__.____..___ Seepage Pit: Distance to nearest well---/(2�?.�.--...Distance from foundation...... ..Distance to nearest lot --------- Number _----Number of pits----- - ------------Lining material �/4.-.....Size: Diameter-----&a..`.....Depth............... ........ 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------------------------------------------ ❑ Distance to nearest lot line----------------------------- --------------------------•----•-•---- Remodeling and/or repairing (describe):------- - ------ ---•----•--•-•---------••--------••------------•--•- -•----•----------•-•-----------------•----••----------•-----------------•---------------------- -----•------•----------•----•--•---------------•---...--•---------••------••------•-----...----------------.._.-..--•------- -•-----------•---•--Z ........ - '. f .... tea- rl�t�s-- ------------------•----------------------•------------------- -------•----------•-•------------------•--•-•-------•------- 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. (Signed)... . `---_ r 9v�a— -•------------------+------------------------- IOwner and/or Contractor) ' BY� ..... ------ --------------------------------------------- ----------------------(Title)------- ---------- -•- - --- ---fes......-- .... (Plat plan,showing size of lot, locati of system in relation to wells, uildings, etc., can be placed on reverse side). R DEPARTOT USE ONLY APPLICATION ACCEPTED B -- - - ----- --- --- ---•---------------- DATE----- REVIEWED �aA-- BY - ------------------------- DATE-- BUILDING PERMIT ISSUED...-_--------------------- - - -- ------- ATE Alterations and/or recommendations:-..---/.-_�' '___ - - ---- _~__ ___------------------------------------- y --- --------------------•----•--•---........_.........__..«-..............._.........__...-......._...--------------- ---------------- ------------------- ------------------------------------ -- ------------------------------------- .._-_---------..-............................................................................................................... 'i .............................. FINAL INSPECTION ..........- ------------- -- --- Date--- ---- ----••- - -'��.-- •-�----------------- --- •-------- SAN JOA IN LOC HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 203 West 9th Streit Stockton,California todl;California Manteca,California Tracy,California ES 9 REVISED a•S9 2M 5-62 ATLAS f