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F OFFICE USt:: : U �9 (_ _ / =3 C., �" G -----------------------------------------____________________________ APPLICATION FOR SANITATION PERMIT Permit No. ...,...��... ......... ----------------- (Complete in Duplicate) /l1 -- -- - -- ---- ---- ------- Date Issued ..-_----..-1...I__� --------------------- ---------------------------------- This Permit Expires 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. 11-1\_&_� S a JOB ADDRESS AND LOCATION— ' rr� ` .........______ Owner's Na --- �.. Phone .. �4 ------------------------ Address --------------- -- -- f \ Address-----•---..._....- ----------------------•-------------__-_---_-___--••--•--------___-___............ Contractor's Name-------------- - .. E j ...............................-..................... Phone . ..__.... Installation will serve: Residence'n--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: J---- Number of bedrooms. Number of baths 2�7--. Lot size ...................I... __4.! ............... Water Supply: Public system ❑ Community system ❑ Private (0 Depth to Water Table _Icr_5ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe 9� Hardpan ❑ Previous Application Made: (If yes,date--------------------) 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 Tank: Distance from nearest well Distance from foundation........LP-----m_aOiial_._er ------------------------ No. of compartments_______-� Size___ � Li uid de th_ ��____________________Ca acitY....`..� .......tt Dispos I Field: Distance from nearest well....4`�_ ... Distance from foundation_____ _ __ ___}_____Distance to nearest lot line................. Number of lines____________`1!:_-_______(_.__Length of each line..............................Width of trench______.___________._.._............ Type of filter material._.._ Q_ _ .Depth of filter material----l_ _` _ _r__________Total length____�_ _ ��____________________ Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits______________________Lining material-----------------------Size: Diameter........................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---n----------•-------•--•------------------------------ - ••----------...----------...................................................... Remodeling and/or repairing (describe):_____-----[_l:Q'-w__ cam.. Y ti4C _ _ ...................................................... -----•---•---------------------•----------•-------------------•-----------------------------------------------•--------------------------..-------•------------------------•-----------•---•---------•----•----••-••-----...._ -----------------------------------------------------------••-----------------------------------------------------------------------------------------------•------------------------•---•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances/Sitaff laws, and rules end regule+ions of the San'Joaquin Local Heal+h District. (Signed)---- --------<�-t ----- ---------------- - -----`------------ ------ti---------• ---•-( ner and/or Contractor) Br- ------------------------------------------- --=...................................----------------------------------(Title)................................................................ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP TM T USE ONLY APPLICATION ACCEPTED BY---------------- ------- DATE ` - '- - REVIEWEDBY --------------------- DATE.-•-------•-------.....-----------•--------.._..--..------. BUILDINGPERMIT ISSUED..............................................................-...................................... DATE............................................................. Alterationsand/or recommendations:---------------------------------------------------------------------------------------------------------•---•------------•--•--•--------------•-----••------- ---------------------------•--•...--------------•--•••-•---------------------------------•------..._..._..---------•-•-•-...-•---•---•---••--••---•---------•--•_...._.•-----•-------_..__....•-••-....•----•-••----•----•---- .................... .......-................................................................................................................................................................ ----------•-•-•-••----------•- ---•-•---....-•------------------•-•---------•-------------------------------------------------------------------•-----------------•----------...--------•-----------••------•----------••-......------••--------•-••------••- -------••-•-------------------.......................................... ...... .--...._..... ....................................................................................................................... FINAL INSPECTION BY:---- --------- Date---------t......................-1. 1 ................. SAN JO IN LOCAL-HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 203 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-69 YM 6-61 ATLAS - ...