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FOR OFFI 0,P7 0MOf ..------.`----- ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------- - --- --- -- (Complete in Duplicate) f/ This Permit Expires 1 Year From Date Issued Date Issued ....,7 Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herein describes., .. This application is made in compliance with County Ordinance No. 549. � � � r r ® :. JOB ADDRESS AND LOCATIQN ' i[i ------ ------ ------ --- '-_----- -, ... ------- ,. Owner's Name-----4._---_..-_ ._ ---• •--------- Phone.................................... ` Address.----- -----------------------------------------_-------------I----------------............................................. Contractor's --- ----------------------------- Contrector's Name. -----_----- Phone................................... . Installation will serve: Residence [Apartment House ❑ Commercial [-] Trailer Court E] Motel [3Other E] � Number of living units: I..__ Number of bedrooms Number of baths _�- Lot size ._APry4' - ....-•-•------- Water Supply: Public system ❑ Community system ❑ Private [Depth TOWater Table __&P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe Hardpan []- ' Previous Application Made: (if yes,date--------------------) No Etr New Construction: Yes Id No ❑ FHA/VA: Yes�rNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) L � r �. I Septic Tank: Distance from nearest well` d_..__.._Distance from fou dation_ ®_____________Material_.-..___- No. of compartments-------Z_-------------------Size---3 ------Liquid depth------f-- ----Capacity d r-r�'�5 P tY---- Disposal Field: Distance from nearest well_i 0-___- /O Y Distance from foundation_....._•____.._.____Distance to nearest lot line. �` Number of lines--------Z.----_-__-_-_----_•-Length of each line----7 -------------------Width of trench_o `_'-------------__- Type of filter materidl�G4!�----------Depth of filter material__4i__---------____Total length----,..__...__.__----------. Seepage Pit: Distance to nearest well__ `--------------Distant from foundation__,� _�__..__-,Distance to nearest lot line__• 5�-f,- ______Linin material__Qlf--___-Size: Diameter____s "! Depth____ � Number of pits----D2-_____- g 3" Cesspool: Distance from nearesf well________________ Distance from foundation---.---------------.Lining. material.............. _. . ❑ Size: Diameter--------------------------- ----------Depth--------------------------- ------------------ -----Liquid Capacity.. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.___-.-.----------------.____.__________- �f` Distance to nearest lot line--- ------- ________________.__._-_________._._-_ Remodeling and/or repairing (describe):_�.'-�� _---_�:------------ s/s 8 -- •--•-------•- --•--------------- -------••--------••-------------•----------••----•----••---------------•----- ------•-----------------------•-----•-•----------••--------•----------------•----------•-------------------------------------------•---------••-------•-------•••-•------•-----._--.---•---.....---------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County otdinances, State laws, and rules and regulations of the San Joaquin Local Health District. \A (Signed)-------------------------------------------- (Owner and/or Contractor) By:- -------- -.:.. - -----------------------(Title) ... i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FO DEPARTMENT USE ONLY APPLICATION ACCEPTED B ___ ----- ---- --- - --- -- ---- - --- ---- --------------------- DATES f VIEWED BY --------------- ------- DATE.-------------•-----_-- BUILDING PERMIT ISSUED-------------------- -- - DATE.___________•-•-•___-- } ------------ Alterations and/or recommendations:._.- ___,C - - ---- ------------------------------------------ ---------------------------------------•---- ---------------•-•------••---------•----•- •--------- -...--------------•--------•--- --•---------------- -- ................... FINAL INSPECTION BY:../f.-. !! - - --- - ---- --- -- --- ---- - -- Date- r. _ _ ...-- - - -- -- - �--------------•--- SAN JOA IN LO L HEALTH DISTRICT J 130 South American Street 300 weal oa Street 144 Sycamore St et 205 wpr 4th Supt � Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 9-59 2M 5-62 ATLAS } i