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F.-OR'OFFICE USE: " .. ` '• APPLICATION FOR SANITATION PERMIT Permit No. ... ---- - Expires ' (Complete in Duplicate) Date Issued ..... ___________________________________ This Permit 1 Year�Frorn Date Issued ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ' 3h`is application is made in compliance with County Ordinance No. 549. Owner's CATION - - - ---------------� �---�'-------- JOB ADDRESS AND L - -- �- �'.�� . _�_ Phona_ _.. ..-----• ----- Address-- _ . ..... .-- ----- --- Contri3ctor's Name = - ------•-- =� ---- Phone. - - - .: .. . t ..ti4 I r Installation will'se'rve: ,Residence, A aetment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1._._ Number, bedrooms __Number of baths _aZr7Lot size ___ A2 w t ! Water Supply: Public !system ❑ Community-system❑ Private epth to..Water-Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy L am []/Clay Loam [I 'Clay E] Adobe ardpan ❑� t i Previous Application Made: {If yes,date-------- -----------I No New Cons r'uctiora Yes o ❑ FHA/VA: Yes E3 No . STYPE OF INSTALLATION AND SPECIFICATIONS: - # (No septic tank or cesspool permitted if public sewerisavailable within 200 feet;)i, ' It - - t S"P Liquid xp ,' Nod of cpm artments ,... Size.- `�-------------- i uid de th--•-•----j------------------. . .............. tic Tank: Distance from nearest well_.______________Dista from foundation-________._____ Ma#erial-----------------------------------Capacity p _ - P tY ` isposal F' Id: Distance from nearest well.-.__-._>__-___.-Distance from foundation_________________ Di#6;hce to nearest lot line....___..________ Number of lines------'--- •----------..^__-:':Length of each line........................ ....Widthyof trench-------------------------------•--- t Type of filter materiel_________________ ___Depth of filter material.-__________ ---------Total`Iength_...-___...._.__............_.__....`_____ . {{ t ! t f .____.Distance to•nearest lot line___ Seepage Pit: Distance to nearest well_�(g _'___Distance from fndation-�D__ . •.-_"-•• /__________-Lining material_ __.__.__y v Number of 1ts..... _ __---Size: Diameter--. 1?________.___:bepth----.-�5__............ _____ 1 ,? Cesspool: Distancei,from nearest.well----------------- from-foundation____.____.________.Lining material.___:_____________....:....____.____. Size: Diameter--------- --------------------------De th--•----------------•-- r --------Liquid Ca aci ••--•gals.. % I Privy: Distance.from nearest well____________________"_"__..._ a' ---------:--- -DistancezfrAom,nearest building------- ------- - an ❑ Distance to nearest lot line-- - ---------�-------=---------- ---= ------ ------ •---•-•-------------------- --•---------- ----------- ; - } Remodeli and/or repairin' ceibe]:____ _ :v~_.__-- ._-- - . _ / = f �_ --------•--•- ------• --------- •--- - ... --------- {�....._...---•--------- / -. --- - --------•----------•----------- - ----------•----____--------•-•-•-••-------•------•••••---••- �M::W .---,; I • , ----t - --------------------•---------------------- - -------- ------=-•---------. - I hereby certify-tkat I have prepared this application at tha the work will be done in accordance with San Joaquin County' ordinances, S ate laws, a rules and g lations Jo in Local Health District. (Signed).__ �� --- ~---------�--_ �`� .._(Ow(Owner-and/or tor) - ---- -------------------- - �. ! r ntr {Title-•-- ---•- ----- a,r__� e� , (Plot Plan, shot of lot, to n of,system in relation to wells, buildings, etc.,.can be pl ed on reverseoide). FOk DEPARTMENT USE ONLY, '} APPLICATION ACCEPTED.BY- ------- - -- --- -------- - - -------- ---------------•----------------------- DATE---------- • 1 -6..�_-------------- REVIEWED BYI ------ -- ------------------ -----------------------------••---- DATE.... BUILDINGPERMIT ISSUED--------=' 1----------------------------�-=--------------------------------------•------ ___ DATE--------.-------•-------------------•--.... ........... Alt rat' ns a d/or recommendations------------------------- ----------------- -------------------------------------------------------------------------------------------------- - _,_. r= ------------------- ---------------------- -_ r 1 y ------------- -- ------------- -•---"------------•-- ----------------- -- ------------- = -; --- --:----•---r-a--•---___... _. F1NAL INSPECTION BY:. -------------------- Date-- - 1 --- ---- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stroh 300 West Oak Srreet 124 Sycamore Street 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California ] E5 9 REVISED 5-59 21A 5-61 ATLAS 1 -