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FOR OFFICE USE: -, f (� -------- ------- �_�-r l`�-- Permit No. ....../:�1--•L-�� ------------------------ APPLICATION FOR SANITATION PERMIT ------------- ----------- (Complete in Duplicate) Date Issued ----------------------- -------------- ---.----.--- This Permit fx ires.l Year From Date Issued Applicatd. ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe This application is made in compliance with County Ordinance" This 549. V JOB ADDRESS AND LOCATION.__ _..._7__s?, _..-- - •�.e ---------------- ..............4�ff T` �'� [ phone--------F•- Owner's Name.... .. .&Yl +'v°-eL' C/t-4-�`- a'C�>� _. ------_----- Address one 1 .-- ------------------------------------ ••-------------- - - Contractor's O her ❑ Installation will serve: Residence ( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Number of living units: .--_--- Number of bedrooms -_I_-- Number of baths �-.. Lot size ..-__-�®_._.�+__-_--••Q-•--- ....................... Number system ❑ Private ❑ Depth To Water Table `s_. ft. Water Supply: Public system ❑ Y Y y Adobe©Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ o FHA/VA: Yes -] No ❑' Previous Application Made: (if yes,date---__-- ---___-_--) No Q New Construction: Yes ® ❑ TYPE OF INSTALLATION AND,SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) \ from foundation Material-:_------- Septic Tank: Distance�from nearest well----------------•Distance Liquid de th-- Capacity tY No. of compartments--------------------------Size--------------------------- -. � Disposal Field: DistJ.ance from nearest well-----------------Distaof rom each line --._:_'::::Width ofstance ttrenchest lot line r Number of lines----------------------------------- Type -------------- •----------•-• LengthTotal length------.---Depth of filter material----------------J g - M Typa of filter material............... Seepagge it: Distance to nearest well from foundation_.....©___..-- Distance to nearest lo}ine...___.____.---_- `� r Depth t ��` -..:. i 0 Number of pits------- -------------Lining^maternal--.I__�---....--Size: Diameter ------------ - -- - y Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining materia_.-.--..._-.__._.---• els. --•-De •• -Depth ---------------------------------------------Liquid Capacity------- -------------..-...g ❑ Size: Diameter------ ----- P Distance from nearest building------------------------------------------ Privy: Distance from nearest well------------------------------- ❑ Distance to nearest lot line-------------------------------- -------------------•-------------- 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 I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. t' / < - � i . -----•-------- ------------------ r- ---•-• (Owner and/or Contractor) -(Si (Signed) -------• - i:------ (Title} r � BY:----------- --- ----------- � (Plot plan, showing size f lot, location of system in relation to wells, buildings, etc., can be placed on reverse i el. a2,P. I FOR DEPARTMENT USE ONLY / �-�--- ---------- ----------•----...- DATE--------- � � by --- APPLICATION ACCEPTED"BY------------------•--------- DATE-------- ------------------ -------------- ---••------- REVIEWED BY-------------------------------------------- ------- DATE------------------ ----------------------------------- - - BUILDING PERMIT ISSUED--------_-------------------- -:_: Vit?-.:�:.k_-:-----.------- Alterations and/or recommendations:-_., -- - - -- ----- -�------- �-� ---- ----•-------- ----- ---- FINAL INSPECTION BY:----- _ __ ---- �----� - -`' Date { =�..� --------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 west 9th Street 130 South Amwrican Street Tracy,California Stockton,California Lodi,California Manteca,California ES 9 REVISED a-59 2M 5-62 ATLAS