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FOR OFFICE: ----- ' ` -------- ------------ ------------------------------- ----- -_._-..-__._ _ . ;r;.------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .1 ... -------------- --------- 4,24-0 (Complete in Duplicate) ------------- .- ---------------------- This Permit Expires 1 Year From Date Issued Date Issued .._.. ..Np . .7� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC TION.....-��--Z. ......... -- ..... •-------- -----------------••---------------.................------------------..........._-_..,. Owner's Name------.. ..... ' •--------- Phone.................................... Address-----.---- -• ------•---•-•••--•--.-•...............•---•-•••............_....•--•-----........-----------.....-------•--...-----........--------- Contractor's Name--•--•----------•....sem.... _1 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 08101community system ❑ Private ❑ Depth to Water Table "it. Character of soil to a depth of 3 feet: Sand ❑ Grovef❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe R— ardpan ❑ Previous Application Made: (If yes,date--------------------) No [E�' New Construction: Yes ❑ No W3' FHA/VA: Yes ❑ No g�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S//eptic Tank; Distance from nearest well................:Distance from foundation....................Material................................................. �� !if��j�l No. of compartments........................7Size................................Liquid depth--------------------------Capacity....................... Disposal Fiald: Distance from nearest well -----Distance from foundation.../P.........Distance to nearest lot line-1. ........ 4 Number of lines........... .. � � � a�-�------------- Length off. _--y-�--pp��;--------Width of trench._�.�.......--------•-•------- 7j H(! material. ,, 66 A Total length....` f� Type of filter material._ ._ __ p,,i4.Do tbr'of filter materie'I ____ Is fi p; s� f Seepage Pit: Distance to nearest well----fir_.=__.—-------Distance om foundation';_.x,7 ..`...Distance to nearest lot line.. .......... �( ®� Number of pits------I------------Lining material $G�'_____.Siza. Diameter.- .' ...___._-_Depth__. _ _./............... Gy Cesspool: Distance from nearest well-----------------Dist Ice from fotfndation---__._.__-__-___.Lining material..................................... Size: Diameter------------------- .DePt ! - Liquid Capacity .------_ gals.El Privy: Distance from nearest well-------------------------------------------------Distance from neare;t building.......................................... ❑ Distance to nearest lot line-----------------------------------------------------------------------._..........-•--...................................................... 15PRemodelling and/or repairing (describe):----- _------ --- --- A --------•-----------•-------------------------------•---------------- -•-••--•----•--------------------------•---------------• -------- -------•-••-----------•---•--•---------•-••-----•--------------•---------•---------------•-•---•-------••----••-----••------•-----------.................................................................................... --------------•----------------------------------------------•--------------------------------------------------•---------------------------•------------•-------- ........................................................ 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. (Signed).............. ; ---------• ----------------- ----- •-- ------------------------------------------------------------(mor Contractor) By:--------`-.---------•--.•---------------------------------.----- --------lof1 -----------------------------------(Title)------. ------------------------•----- (Plot plan, showing:size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- •----- DATE•-• --•-N-----� REVIEWED BY............................................. DATE----------- 17 BUILDINGPERMIT ISSUED--------------------------•-•----•---------•------------------••-••-•---•---••-•-•----------•-•---. DATE............................................................ Alterations and/or recomm ndations---------------- ---------------------------------•-- ......__.__.-•-----_--------------------------- ...... ------------------------------------------------------------------------ ------------------------------------------------------------- ....._...---•-- ------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------:.....---•-••-•---.... -------------------------------------------- -------------------------•-- ----...-------•--•------.._....----- ........................................... ------------•.................................................... FINAL INSPECTION BY:.--- ----------- Date----- --- ..------•----------........ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wort Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-89 2M 8-61 ATLAS