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FOR OFFICE U : •-------- 3 L- J3 '`APPLICATION FOR SANITATION PERMIT Permit No. .. ... ....... -----�.3------------------------------------------------ ------------------ --- -! 7/ --------------•--- ---------- ------------------------ (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 nstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �� Et- ao�o S�- t �= F- -. -�...---- JOB ADDRESS AND LOCATION � D,------------ -• d ., l... Owner's Name _ `-- Phone. . - Address---------- �� = ----------------Y---------------------------------------'-----------------• ------- ...-------------•_----- -------- Contractor's Name.-- - -----�/ 4--- _ --- ---------- ----- ..__..--..-_:....- Phone....... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: __. Number of bedrooms%,K_ Number of baths S__ Lot size _, .-� � Water Supply: Public system ❑ Community system ❑ Private ®`Depth To Water Table' f+ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [ Previous Application Made: (If yes,date-------------------JJ No (2r"' New Construction: Yes ❑ Noe.�'FHA/VA: Yes ❑ Not- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept` Tank: ' Distance from nearest well_.--__-____--__Distance from foundation-----------_______.Material-------------------------------------.-.__-_.__-- Size------------------ --Liquid dePth------------------- ---- Capacity----------------------- J014 No. ofcom artments-- m - Disposal Fields Distance from nearest well.............�___pistance from foundation--------------------Distance to nearest lot line____...-.__--.-. �I �1 Number of lines------- -------.:,_'Length of each line-----------•-----------------Width of trench--------------•-----•--------------- Type of filter-material......:_-----------_-`Z_-Depth th of filter material____-_ � Total length_-_______._-_.__-•_---------...-----_---__ � r , a Seepage Pit: Distance to nearest we1L_ e.�_____--- Distance from founda#ion__- ...__-_.FD�i 'ice to nearest lot line___ ®� Number of pits-------�.---------=Lining material---/ - --Size: Diameter_..__ _.......Depth--,24 ----------------•-•- Cesspool: Distance from nearest well_________-__-__.Distance from foundation--------------------Lining material------------.-______-________...... � -' ------Depth-----------=--° _•---••--------------._.-=--._Liquid Capacity----------------------------gals. �'- ❑ Size: Diameter--------•------------------- - Privy: Distance from nearest welh ___----____________--- _-------Distance from nearest building------------------------------------------ _-1 ❑ Distance to nearest lot l,De,----------------- -- -- --- •-••------•--------••-------------..----•-----------•---••----.-._--------------------------- -- - ----- -- - - �41 Remodeling and/or repairing [describe)-------- --- --- -- . / ------ --•--•-•-------------------------•---------------------------------------- _______ ------ ---- ------------------------ N---------------------------------------..---------------- --•----------------- --- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule and regulations art the San Joaquin Local Health District. -----------townermuVor Contractor) By=---------------•--------------------•--•---------------------- --_,, -�f --•:....------•------------(Tiiflel ��Z/l&-• --- ---------------- -------------- (Plot plan, showing size of lot, location of syste t relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --�L_ ___-_ DATE-----------7--- ------- -- - ------- ___--- ---------------------------------------- REVIEWEDBY--------------•------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------- - -----• DATE--------------•-------------------------------------------- Alterations and/or recornmend'a ions:--------- ;------------- -- ...................... ---•---- rT FINAL INSPECTION BY:.__j-I------- -------------------------------------------------------- --- -------- -- Date.-- 1-- ---•r-- -�--• -----Z----------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street —300 West Oak Svoot 124 Sycamore Street 205 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 ZM 5-62 ATLAS