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FOR OFf ICE USE: :____�........:.... 1;_ _�_._______;''�� ' APPLICATION FOR SANITATION PERMIT Permit No. ..� :�'�..._ '.:. ----------------- ' ---- ---------------------- (Complete in Duplicate) - ------------------ This Permit Expires 1 Year From Date Issued Date Issued ..... Application is hereby made to the San Joaquin Local Health District for a permit to construct gn�ItstallA wor�eirydes�. This application is made in compliance with County Ordinance No. 549. , /��j ;/� h JOB ADDRESS A"LOCON--- 7 i_..___ f'I '1Owner's Name---- Phone._99'70j�A/.. Address /-------- ------ - -----`" -------------- ---------- ----------------- - k Contractor's Name. / - '� / D Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..!... Number of bedroomsY Number of baths __/. Lot size , °__3c...,f V............... [I Water Supply: Public system Community system �4ivate ❑ Depth To Water Table weft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[2�'gardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No4ET'O'�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j* o Distance from nearest well__l'_'T,_ .__Distance from foundation....................Material................................................. No. of compartments-----------------_------Size....---------------------- Liquid depth--------------------------Capacity....................... e iel Distance from nearest well.A-Q .-Distance from foundation...../49.:_._..Distance to nearest lot line.....WW_�.�� Number of lines.- ------ _____________ _ '-Depth Length of each line...... O__ °_._.___....Width of trench._�SC.!!................ Type of filter material._ :-__Depth of filter material____- -`'-----Total length............... ............. .-�............ S i ! Distance to nearest well_'.S�_E?_______.._.Dlstance from foundation_....___..Q.... .Distance to-nearest lot line....__SX.... . Number of pits___._---------------Lining material_�>Z�_.._..Size: ................. 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 Remodeling and/or repairing (describe):-------- ------------ -----------•. . ------ ' ----------------- - � . -- -------------- ------- ---- �tl --------------••-------------------------------------- -----------------------•--------------- - ----------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S aws, and ruleC .s and regulations of#e San Joa In Local Health District. (Signed) -�4-- { / // l ---- f/f� - ( Contractor) By:................................................................. -- ----- A. - ---------(Title)-----------------------------------------._... ------------- (Plot plan, showing size of lot, location of system in relation wells, buildin , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ _.______`- — --- / --------------------------------------------------------- ---------- DATE..----- ---- ----------------------.. REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE BUILDINGPERMIT ISSUED----------------------------—-------------------------------------------------------------- ------ DATE..... i . .Z�Alterations a d/ recommendations:..... " • It-ea ------------------------------------------------------------------------------------ ---------------......................................................................................................................... -----•------------------------------------------------------------------------------------------------------------- --------------------•--_................................................................................. -------•-------------------------------------•------------------------------------------------------- ------------------------------------------ ..................... FINAL INSPECTION BY:......<.'.�l--- -.--.--. - It 1167 -------------- Date.--------------.. ..................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLAS