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FOR OFFICE USE: 3 V APPLICATION R SANITATION PERMIT Permit No. --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 construct and install the work erein d crbed. This application is made in compliance ith County Ordinance No. 549. JOB ADDRESS D LOCATION ------ Owner's Nam ----------------------------------------- ---- Phone------------------------------------ Address_. . ? Contractor's Name-------•----------- --Q. 'I( 4- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court (3 Motel ❑ Other [3Number of living units: .-• Number of bedrooms T'' Number of baths _,Z__ Lot size --1�- - —_-----------_----- Water Supply: Public system ❑ Community system ❑ Private10 Depth To Water Table Ad_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date:-------------------I No ❑ New Construction: Yes ❑ No W FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0 is Taitk: Distance from nearest well________________Distance from foundation-----------------_Material._____.___-__--_______.____._____.__________..... No. of compartments----------------------- Size----------------- ----... depth-----•-------------• apac City......------•------ • -- -- --- Distance from nearest wellI16-------Distance from founds ion_ .f ♦. Distance to nearest lot l�___7____._. �/ Number of lines_________ ___ __ ___/}___Length of each line_ _ Width of trench__ Type of filter material_ _)P4!rk___-Depth of filter material..._.12___-____.Total length-----------------------9_Q--------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line....------------- M Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------..----------- Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material___.__._____-__-________.....__-_- ❑ Size: Diameter--------------------------------------Depth--..-------------------------- ---------------------Liquid Capacity----------------------•-----gals. Privy: Distance from nearest well--------------------_----------------------------Distance from nearest building____________.--_-_______•_-_.-_____._--.. ❑ Distance to nearest lot line---------------------------------------------------------------------------------.---------------------------------------------------------- Remodelingand/or repairing (describe);------------------------------------------- ---------••-••------------------------------------------------ ---------------------------------------- ------------------------------------------------- ------------------•------- .....I ---------------------...--------- --••--------•-•---------------------------•--------------•---------------•----------------••-------•-------...-----------------------•----------- 1 hereb r certify at I have prepare t is application and th t the work will be done in accordance with San Joaquin County ordinances, s, and rel and re u tions of the San JoXin Local Health District. (Signed)•----- -- -------------------------------4----------------------- ------ ------ --------------- •--- -----------------------•------- Wr and/or Contractor) .. By-------------------- --•-----•••-----------•---•----•---- ------ ----------------...(Title)----------- - ---e---------------------...._..------- --- (Plot plan, showing size of lot, location of system in relation to well uildings, etc., can be placed on reverse side). F R DEPARTM T USE ONLY APPLICATION ACCEPTED BY ---------------------------------------- DATE G REVIEWEDBY--------------------------------------- ----- ----- --•--------------------------------•------- DATE--•----. ..... ----------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—----------------------------------.... DATE--------------••----_------------------------------••----- Alterationsand/or recommendations:---•---------- -•- --- -----------------------------------------------•------------._......--------••-----•-----....------------------------------------------- ------------------ ----------•-•----------------••----------------- ----------------------------------------------•----••------------•-•-------••-_--•-•----- ---•----•----•------------------•---------------------- ---------------------------I---------------------------- ---------•------•-----------------------•---------------------------• ------------------------ -- -•- ------------------------------•--------------------•-------••-....---------•--------•----------------------------------- •---•----- 122 FINAL INSPECTION BY ------------ date { _.. �3 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS -