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n � FOR OFFICE USE:. ------------------- .1 ----------------- / �.1h ___._. �t3� _�_ <`:(� APPLICATION FOR SANITATION PERMIT Permit No. ...).�,�....��5 - ----------------- _ _ (Complete lete in Duplicate) 3 .ZDate Issued -_.�TI ------- _ _.-- -- --- 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 ii'#all the work herein described. This application is made in compliance with County Ordinance No. 549. �--JOB ADDRESS AND } TIO ' d / = ' -` : ,Cpl. ., �fQ -------------- Owner's Name .----•-=�------. • -- ...... =x:... ;r------ ---- Phone.................................... Address._... 4-5 , .Contractor's Name-------••--• - --------- f —----------------- Phone Installation will serve: Residence JE" Apartment:House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ gther ❑ Number of living units: .___ Number of bedrooms _3--- Number of baths __- Lot size ............................... Water Supply: Public system ❑ Community system❑ Private [Depth To Water Table �ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam C] Clay ❑ Adobe[B-'Hardpan ❑ Previous Application Made: (If yes,date---------.----------) No (R- New Construction: Yes Iao' No ❑ FHA/VA: Yes Or No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,,��rr�� s Septic Tank: Distance from nearest well_-_X41------Distance from foundation---Z4......-.__.Matejiai e-_cJv _. t�. ...: ................. No. of compartments-----�•--:--------- ------Liquid depth----yk�1 Capacity. ��.... Disposal Field: Distance from nearest well--- ------Distance from foundat'on._ __:__._Distance to nearest I� line.e ....... � Number of cines-' �. _ --_-_ Length of each line___ __ Width of trench.__. ....................... ,� �--- Type of filter material./4 .---Depth of filter material_._ : Total length Seepage Pit: Distance to nearest ell----- _._____Distance from foundation..... ®........Dikance to nearest lotItis;. ........ (e _ _ __Number of pits-__: .___ ____Lining material--- Diameter__ _____________Depth._J�'�..___._................. Cesspool: Distance from nearest well.----------------Distance from foundation----------------_----Lining material..................................... ❑ Size: Diameter-------------------------------------Depth-------------- ---------------------------- _-.Liquid Capacity-_-_----•--------•------gals:, Priv Distance from nearest well.--.--- __.------.-----------------------------Distance from nearest building ❑ Distance to nearest lot line-------- ------------------------------------- ------------------------.......................... Remodeling and/or repairing describe - - = ----------------------------------------- ------ ----------------------------------------------------------- s --- ---- ------- •-- -----••--•••....... _ ------------ ---ac:..... -- -- , -------------------------------------•---------------------------------• --------- -------------------------------------------------------------------- --------------------- ------------------- ----------------- 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 an regulations of the San Joaquin Local Health District. (Signed)------------------------ = / ------ ( r Contractor) By:.......................................................... ----•------------------- - --------- (Plot -------(Plot plan, showing size of lot, location of system in relation t ells, buildings, etc., can be placed on reverse side). FC)h DEPARTMENT USE ONLY 41F. r APPLICATION ACCEPTED BY.... ------ -- -- - --------- ---•--------------............----...... DATE... ------------ REVIEWEDBY-------------------------------------- -------------------------.......................................... DATE....................................................... BUILDING PERMIT ISSUED----_---------------- ----------------------------------__---------- -------- DATE............................ Alterations and/or recommendations---------------------------------------------------------------------------------- -•----....------------•----------------------•------.........•---_._... ----- ....... ------i . ---- --- - - -- - _ �--- ---_--- --• . _ .. . -- •--•--- `- ---- �J ----- _ ---- --- FINAL INSPECTION BY/------- :___ - ----- --------------- 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 a-59 2M 5-62 ATLAS