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*F012 OFFICE -------- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ------------- This Permit-Expires 1 Year From Date Issued Date Issued I -F3-31 0--LS Application is hereby made to the San Joaquin Local Health District for a permit to constructr�iJ11 ork in descrbThis a lication is made,.in compliance with County Ordinance No. 549. �� 2 s JOB ADDRESS AND LOCATIO ....... : Owner's Name_----------------- -•-- ...... -- ------ ---- {✓. Phone = Address........ d 3--------- -- ------------- k ---- ---------••------•------------ Phone..... Contractors Name.............................•- Installation will serve: Residence W Apartment House ❑ Commercial ] Trailer Court ❑ Motel ❑ Othor ❑ Number of bedrooms __ Number of baths . .._ Lot size ------ ------ Number of living units: ------------- Water Supply: Public system ❑ Community system ❑ PrivateX Dept i h ro Water Table 2-�ft. Character of soil to a depth of 3 feet:I Sand ❑ Gravel ❑ Sandy Loam 0,. Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: [If yes,date-------- .----------I Nox New Construction: Yes [& No ❑ FHA/VA: Yes-[:] No TYPE OF INSTALLATION AND SPECIFICATIONS: _ N (Na septic tank or cesspool perrrli#ed if public sewer is available within 200 feet.) 1 r% i i- - V Septic Tank: Distance fr MVearesf well.._�Q__-Distance from --__--Size :�-"✓[,/ foun'dation_____l.,r!-------Material________ _________ No. of compartments---------T -----.. �,Y- -LI uid de th____ �.r. _____--- Cpiy . Disposal Field: Distance from nearest welL:_5�. m"fou _Distance frondation-_--? _____.Distance to nearest lot line------ Number oft lines......... __.. -_.__Length of each line_-___�____ - - Y----• -- 9 ---cd-f----Width of trench----------- ----------------•--- r. Type of filter mat erial._ r-Depth of filter materiall.. . '� Total length �- mss•-_-+ 9 r.. 6 Seepage Pit: Distance to nearest well----------------------Distance from foundation_________...----_Distance to nearest lot ❑ __ lin•e.._.__.._ Number ofpits -•\- Lining material--------------------- ize: Diameter---------------•-------Depth------------ _ __._._...._ .-_-.-.-.-_•_•.- ro Cesspool: Distance from nearest well-______________Distance from foundation.. ----------------Lining material----------------------...._______-_-_ ❑ Size: Diameter----------------------- ,__-..De th-----------I/------ I -Liquid Capacity Privy: Distance from nearest well------------__----______________--------------Distance from nearest building------------.-------------------- ....... ❑ Distance to nearest lot line-----------•------------- . � Remodeling and/or repairing (describe: ---------- ---- ....-------------•-----•----------------------•-------------------------•---------------------•---•------- -----••-•---••----------------- •------------- - 1 # ---------••-•-------------------•-----•---•--- - ------------------------------------------------- -------------------------------------------•----:--------•--------------------•----------------•------------•----------•------------•----•--------------- 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. 4 (Signed)- - ---------- ---{Owner and/or Contractor) B ---- ----- -- - . Title [Plot plan, owingg size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse aide}. i , FOY60ARTMENT USE ONLY APPLICATION ACCEPTED BY_ �"" "" '` "` - DATE ._.2 REVIEWEDBY ------------------------ � ------- ------- -----------------------. DATE BUILDINGPERMIT ISSUED----------_ --------------------------••-----•---•---•--•---------------------------------------- DATE Alterations and/or recommendations:-------------- --------------------------------------------------------------------------------- ------------------------------------------------------------ ..... ---•-•-•--------------•-----------------------•------•-•-••-•-----•-•----------------------------------•------------•--------•----------------•----------------•-------------------------------------------------•------------ ...........................•------------------------------------ --------------------------•----------------------•---•----------------------- •------------ -------------------•-••----------- FINAL INSPECTION BY:--- ..... ... / a Date 1�---------- ----------•-•-•-=-•---•----_- r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street J Stockton,California - Lod[,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS