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FOR OFFICE USE: --------------------------------------------------------- - p APPLICATION FOR SANITATION PERMIT Permit No. rr��. 1.1 ----------- ------------ - -�}--// { - - {Complete in Duplicate} � /(, This Permit Expires 1 Year From Date Issued Date issued __. ,l . Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application-is made in compliance. unty Ordinance No. 549. JOB ADDRESS AND OCATIONj flaw -�-�-.�..- '.-`�' Owner's Name i .'.-_007__-_1 t'J� =Q3.--/Phone-.------------ --------•-•------ Address _.1...._.f�1' _.. -. ................ '---------------...------•----_----- I Contractor's Name---�Y!.7�---------------------------------------------------------------------------------..... ------•-•-- Phone......... .... � . Installation will serve: Residence t Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ J� Number of living units: J---- Number of bedrooms ---;__ Number of baths ;�____ Lot size S.. '!_______________________________________ Water Supply: Public system ❑ Community system [I Private It] Depth To Water Table S' ft. Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe❑ 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--- 9------Distan�cfrom foundation___-.�.�.__------Material--- rr'U ______-•_________________. ® No. of compartments_____ '-----------------Size_15:7.?JtX----- ---Liquid depth----Y-------------------Capacity_-/_�:_�n____._... F �`._' II —1 Disposal Field: Distance from nearest well._ ____.._Distance from foundation__1 a"__........Distance to nears - ' . -- - I . ne S ® Number of lines _ Length of each line../63?J---------_....Width of trench___ - ... Depth of filter mate as----------Total length---P�•__-...............--_--._-_---_-._--_- ............................. Type i Type of filter materia. -- ----- Seepage Pit: Distance to nearest well__I".-----------Distance from l!foundation_-l�!------------Distance to neares C..._- - IN Number of pits___a7r___________-Lining material_Am/---------Size. Diameter_3_3.%------------Depth- _A_F" _ Cesspool: Distance from nearest well-----------------Distance from foundation.__________________Lining material--_---.----_-______________________- ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity------•----------------.._.gals. Privy: Distance from nearest well--------------------------------r-.-------.----Distance from nearest building------------------------------------------ lk%,,_ ❑ Distance to nearest lot line------------• ------------------- -----------•------ ------•-• .....----••--•---..------- ----------------------.--------------------'� Remodeling and/or repairing (clescribe):----------------------------------- ---------------------------------------------------------------------------------------------------- ----------------------------- ------ ---------------•._._..-------------------------------------- --------------------....._.--.......--------------------------.................. ---------------N ---------•---- ----------------------------------------------•------------......---------------------------•-----------------------------------------------------------------------------.-------------------------------- --• ----------------•-------------- --------------------------.........----------------------------------------------------------....--------------------------------------------------.... ----------------------- -----1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ik ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed} -- ----- ----------------- ------------------------- ------------- -----•--(Owner and/or Contractor) 41 ' elation to wells buildings, etc. can be }laced on reverse side). SY_ _ _ _ __ _ ____ ___ _ ___ _ Title -----•------- -------- ----- (Plot plan, showing size lot, location of system I 5 , p - } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...'.4A x�_ __-- ------------------•------•---•---------------- DATE--- -----------------------------� REVIEWED BY-----------_...----- -• • - +.,,. • - -- ----------------------------------------------- ------•- ---•----•-------•---------------- DATE PERMITISSUED................................------------------------------------------- ... DATE..................--------------------------------- Alterations and/or recommendations:------------------------= ---------------------•------...-------------------------------------------..................................................... -----------•---•-----•--------------------------------------- -------------------------------------------------------------------------------------.........__--...-----------•------•----------- / FINAL INSPECTION BY:--,r%��-�'_�fz't�l�!/�--------- --------- Date----j-'.�-�`�--,�-••----- - I SAN JOAQUIN LOCAL HEALTH DISTRICT F 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 B-59 2M 5-62 ATLAS I