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T FOR OFFICE USE: ---ate- , ------------------- _ r. APPLICATION FOR SANITATION PERMIT Permit No. .. 5.�?.�` ---------- (Complete in Duplicate) 7 ' I This Permit Expires 1 Year From Date Issued Date Issued .__�. - .,�'.....__. . _f 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 c pliance wit County Ordinance No. 549. SS3 ., `�� r� JOB ADDRESS D OCATI .d � 4................................................. Owner's Name. ------ I... ................................... Phone.................................... Address............................... 1 i Contractor's Name --------•-- ------------------------------•--•-•--•--•-•-•-••---•---••--•---•--••••-•...... Phone................................... Installation will serve: Residence 0� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ..,... Number of bedrooms _Z_. Number of baths/....... Lot size ...... ----.---•-..- Water Supply: Public system 011<ommunity system ❑ Private ❑ Depth to Water Table_ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand oam ❑ Clay Loam ❑ Clay❑ Adobe ardpan❑ Previous Application Made: (If yes date____________________) No New Construction: Yes ❑ FHA/VA: Yes ❑ No [c}. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well.....__�.Distance from fo,undatior/.v.../..-..Mata,....C1a.Ar.6- 47'.._......._... . - 11No. of compartments...____... ._Size....... Liquid depth_..... Capacity--- Disposal a acitY Disposal elcl: Distance from nearest well--:_----- Distance from foundation/.Q.......,;,,pstance to nearest lot line.... . _Number of lines.-.3--_----------------------Length of each line_*24f.(/4d'.0---Width of trench._--�.5�% Type of filter material.�L�:y _-.--Depth of filter material..._I_��1_-___-_Total length........4.4;--Z.Z. ---------- ---- Seepag it: Distance to nearest welh! ---Distance from foundation..- . .......... to nearest lot line.-, ----/----- N Ey Number of pits...... Lining material_..YDli ---------Size: Diameter.. 3....r........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-----------------------------------------_------ - Remodeiing and/or repairing (describe)---------------- -QA-0....... - •�-�-�-�.1 S ----------------------------------------------------------••---•---••---- ------••-•---•-•---------••-------••---•------------------------------••---••-•------------•---•-----•--•---•--•----------•---•----------------- 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, an and regu ns of the San Joaquin Local Health District. (Signed) -------------------------------------------------------•-----•------------(Owner and/or Contractor) ------------- (Plot plan, showing size of lot, Loc f system in relation to i dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...f'G czy""`� DATE•-• . _.. = - REVIEWED BY --------- Ir : ------ DATE BUILDING PERMIT ISSUED...........................................................------------------------------- ......... DATE--------------- Alterations and/or recommendations-.- ...:. ..........._ ..__-__-___ - ••-• - ----------------- ter-�_ ........... =/-------------------------------------- ------ ---------- - 1—c4 ------•-/`� Q�,�� ------_--------- re-7n:::.............. . .... ............. - l �3..------. ._.-_... _ ` ` c -- -�4 FINAL INSPECTION BY------------ -' --'��r------ ------'--...---. _ Date ------------------- -- ------•------------------------------------------•---• SAN JOAQUIN LOCAL HEALTH DISTRICT r _ 130 South American Street 300 West Oak Street 124 Sycbmore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-61 ATLAS