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FOR OFFI US--- ---- -------- : --- 93i 3d .._. APPLICATION FOR SANITATION PERMIT Permit No. ...1..... . ------ -- ----•-- -------------------------------------- (Complete in Duplicate) ------ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with-County Ordinance No. 549. A JOB ADDRESS AN9 LO TION__--�.�---_2-0. '.Z, / ______________ . Owner's Name...+ -------•-- --------------------------------------------------------------------- ----------------- Phone.......................___...... Address f `5-----• •- - Contractor's Name • `----- Phone................. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --A-: Number of bedrooms .'V-__ Number of baths .2,. Lot size .......770 -.Z,4�.0-_ - --------------------•- Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table 4p ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San Loam E] Clay Loam ❑ Clay E] Adobe®�ardpan ❑ Previous Application Made: (If yes date____________________) No New Construction: Yes UR,01N'o ❑ FHA/VA: Yes ❑ No 2�` 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---,......Distance from foundationj_4............Material__-' ______ _______________________________ 4}/ No. of compartments------V+,.-------------size.... 10-------------Liquid dep?h____ ____.__________---_-Capacity /�� Dispose field: Distance from nearest well..-'__.___._Distance from foundation..AA._-.___.____Distance to nearest 1 t line_.`_____.... Number of lines----------- -- r� ___Length of each line______-_Q__-_______.___.Width of trench-_______._V_____________________ Type of filter mate ria�:_.7/?. t_LZl�__.-__Depth of filter material -_�__ ____________Total length_._... _ Q---._--__-___________. Seepage Pit: Distance to nearest well----~�___-___._.Distant foundation-41--L .Distance to nearest-lofline',--- 0-+- [� Number of ---------_Lining material __Size: Diameter ---..Depth----- ......_---------- Cesspool: � Distance from nearest well_________________Distance from foundation_____________.____.Lining mater.ial--__.___._..__-.-___.__________----.- t) ❑ Size: Diameter---------------------------------=---Depth-----------------------•---------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____.____._.____________-__--___.-_--... ❑ Distance to nearest lot line---------------------------------------------- --•------------------•----------------•----------------------------------------------------- Remodeling --------------•----•------------------------ ---Remodeling and/or repairing (describe)______________ --------------------------------------- ------ ---------------------------- ------•-----------•--•-•----------•---------------------------•----------.••----•--------.---- --------------••-•---•-------•---------------•------------------------------------------ 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)------------------------------------------ •-•------------------------------- ------- --- --- --- ------- • --------------------------------------------(Owner and/or Contractorl By:-----------------------------------•--•--------------------------- --------- ----- -------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - ----------- --- ---------------------- DATE... �j� .�. ___. -C 2 REVIEWEDBY--------------------------------------- -- ------------------------------------------------------------ DATE-------•--- BUILDINGPERMIT ISSUED-------------------------------------------------------------—---------•--------------------------- DATE-----------.------------------------------------------------- Atterations and/or recommendations:---------------------------------I------------------- •---•-----------••------------------- 00 V - - ------- ------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:----- ' .. ------ -- ----- - Date---------J� [ -------- SAN •-SAN JOAQUIN LOCAL-HEALTH DISTRICT 130 South American Street 300 Wail Oak Street 124 Sycamore Street 205 Wast 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS Y_