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FKVFFIC;E USE: --------�� ------------- ------------_-._--.. - --..---..--------- APPLICATION FOR SANITATION PERMIT Permit No. _.f.....7.��_ ------------------------------------------------------ -- (Complete in Duplicate) (0 ----------------------------------------------------- -- This Permit Expires 1 Year From Date Issued Date Issued ._.f... ........:` 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. 17� - 170- 03 4(1 20 `,_.F'ct.c ee-I'�t S 7." yy JOB ADDRESS AND LOCATION...I_ --- `'v --- ! r!1/f' '-av .[!A!-.°c,��o.c ' '�i x�� Owner's Name.---•��------L -•................. + ----------- Phone................................... Address------------------------------- --••----r�--------------------------------•--- Contractor's Name------- ---------------------------------------- Phone................................... Installation will serve: Residence e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_/---- Number of bedrooms o ` __.� Number of baths __.f-_ Lot size .---s- --K/3---------- ,'.__-_.--_-_-..___--_•..._..._ Water Supply: Public system IT-Community system ❑ Private ❑ Depth to Water Table P?_. ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe O Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [a' New Construction: Yes PT—No ❑ FHA/VA: Yes Tr No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well --_Distance from foundation---/0_ - Material...... u ... . ....... No. of compartments--------�............Size....... 3Liquid depth-- • -Capaci.t.y...-...-.-.-b.------ .4..0........... Disposal field: Distance from nearest we1L ._.Distance from foundationjk?/ft.7....Distance to nearest lot line_ ........ UK- Number of lines_______________r------------------Length of each line.........?P-_i-----------Width of trench.__ _-_--� �� (U Type of filter material...�CCck-------Depth of filter material...1-Q--------------Total length......... .�~ �i Seepage Pit: Distance to nearest wellmimo— -4---.--Distance fmm fo ndation.�V___.__-..Distance to nearest lot line---j� ...... Number of pits-------- ------------Lining material----_-- -. --Size: Diameter-----_??..�.... Depth-------.... 4._..-----_---ffl� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.------------------------------------ El Size: Diameter-------------------------------------Depth-_------------------------------------------------Liquid Capacity----------------...........gals. \( Privy: Distance from nearest well-------------------------- -------Distance from nearest building.-----.--------_------------.--..---.----- V E❑ Distance to nearest lot line-----------------------------------------------------------------------------------------------------•-----•---••------------•-------------- Remodelingand/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 regulatio s of the San Joaquin Local Health District. (Signed)------------------------------------------------------------ ------------------------------------------------------------------(Owner and/or Contractor) By:--------------- W------------------------------------------------{Title)----------------------------•--•-------------------------------- 0, ------- --- - -- -•------------ (Plot plan. showing size of lot, Iota ' of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i !,, APPLICATION ACCEPTED BY � -----------------------------------•----------••--- DATE-----/- ` REVIEWEDBY-----------------------------------------V-----------------------------------------------------------------------........ DATE----------------------------------------------------------- BUILDING PERMITISSUED----------------------------------------------------------------------------------------------------- DA•TE..• Alterations and/or recommend ions:.._..--.--•-----•--------------- - - -------•--- .....------- -•- ----••---------- --- ._-_.•.�`-'~' -2•--"- '-+'- - ---•1a�•w�}r•^^-f ---�+ -�--•-'-�-----.- _ "-^ --_ ...../_-s,.. --•r'---------- ----------------------- ......... .......... Y ---......-•-•..........................................•-------....-.-------..-------.-------------_-------_.-..-..-__-_-..-.-----------•--•--------.-------------------...---------....----------------•--------------_--- F]NAL INSPECTION BY -----�) -.-?- Date------ -2 - 6 'Z_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EE 9 REVISED 8-59 VM 5-61 ATLAS