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FOROFFICE USE: ------------I-------------------------------------------- APPLICATION FOR SANITATION PERMIT SCAV�jUj -----------------/- - -- (Complete in Duplicate)---------------------- ------ ��----�- • This Per d ---f---..�./__�-- mit Ex ares 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 herein described. This application is made in compliance with County Ordinance No. 549. q._..,,P-) : f _ 2-17 0 Z'2- JOB 2JOB ADDRESS AND LOCATION_N--L-[f------_--�-0vr( j__ _. --- 1 -aG----------- - Owner's Nam _. �- � , --------------------------------------------------------------- Phone-------..........----------- Address------ ------- �' Gf ------------------------•-------------------- Contractor's Name---- - _ ----••------ Phone.................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units:___ Number of bedrooms,___"- Number of baths __ ___ Lot size __________________________________ ----••------------------•- Water Supply: Public system ZI` Community system ❑ Private ❑ Depth To Water Table -------- 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 ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic an Distance from nearest well-----------------Distance from foundation--------------------Material---------------------------------_._________..__. !� ❑ No. of compartments. Size-------•----------------•-------Liquid depth---------------- ---------Capacity------------------_-•-•- i Dispos Field: Distance from nearest well__-,�Q_�_._Distance from foundation----1�f___.._____Distance to nearest lot line..______.-.-. I Number of lines----------- -------------- Length of each line-------1.090_-„•_---.Width of trench._Z---"------------------_--- I Type of filter material._. Depth of filter material---- l ______-_Total length------- .8�--------- ________________ Seepage Pit: Distance to.nearest well-_____________________Distance from foundation........------------Distance to nearest lot line......__.______-_ (j} ❑ Number of Pits---------------------Lining material-----------------------Size: Diameter-----------------------Dept h_--------------_------.---------- m 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----------------------------*--..___.____- ❑ a 'Distance to nearest lot line Rem04e4rry and/or repairing (describe):------------- -------------------------!i! --- �' �/�'.4--'•� ---------•---•- •---•-----i--------------------•------------------•--------•----------------------•--••---•---------------------------------------- -----------------•------•-------••---------------------------------- ----- -------------------------- ------ •-p------- --- --------------------•---------•---------------------•------------------------------•------------------------------------------ .---------------- � I hereby certify that I have pre'.ared this`a plication and that the work will be done in accordance with San Joaquin County _ ordinances, State laws, and•ules'and regulations of the San Joaquin Local Health District. f a (Signed)______________ �� --- jew. land/or Contractor) a By:---------- --- --- -------'----- -----��. - - - ------(Title)------- ---------•---------- ---------- --- ---- --- (Plot plan, showing size of lot, location of system in re.aI tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._ - . _ -------------------------------------------------- DATE...------------------- - - REVIEWEDBY--------------------------------------------------------------------------- --------------------------------------------- DATE-------- I BUILDING PERMIT ISSUED------••---------------------------- •------------------------ DATE Alterations and/or recommendations----------------------------------- ---I----------------------------------- -------------•----------------- -•------------- ----------•------------- ---------------..-----------------------------------------------•-----------...-------------•----------•--------•------------•-------------•----•--- •------------------------•-----------•---------------------------- -----------:------- ------ --- ------- ------• ----•----- ------------- ----•---•---------- ---------------------••---•--------------- ----------------------------------------------------------------- FINAL INSPECTION BY -------`-- Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Weil Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED S-59 2M 5-62 ATLAS =