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-OR OFFIUSE: . 4---------- --------------------- ------- ---- APPLICATION FOR SANITATION PERMIT Permit No. _. ._ ------ 1 24 (Complete in Duplicate) ` This Permit Ex ires 1 Year From Date Issued Date Issued This application is made in compliance with County Ordinance No. 549. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. JOB ADDRESS AND LO ATION._- - --20 Owner's Name______________ ------ -----------;------------- Phone................ •------------------- -- -- ------- - ----- ---------•-----------•---------- Contractor's Nama_:_-_____ ----------------•-------....__-------------------------------------------- Phone.......... Installation will serve: Residence (Ijo'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: - :-- Number of bedrooms � -- Number of baths �,.._ Lot size .��.. - -f •:, ........................ Water Su I • Publics stem �'_ PPY• y ❑ Community system Private ❑ Depth To Water Table 02-1-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] L�Adobe Hardpan ❑ Previous Application Made: {If yes date.___-___.__._------) No !,7 New Construction: Yes No ❑ FHA/VA; Yes W�— No-[D 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 f undafion. L I [ J0-----------.Material_.. _+ No. of compartments_____ `'r ' Size JG Y__:;V*1iquid depth___- �- ------Capacity; Disposal Field: �-- Distance-from-nearest w0--!1!r= ----_Disfance from foundation--- �� T e of filter mat Distance to nearest lot line__�___. Number of lines_-- _ Length of each Gne._��-------i'-------- Width of trench__A_�. -••-__- �/ ------- Type erlal. - Depth of filter mafierial____,� •___-_---Total len th___ __ Seep Pit. I Distance to nearest well----------------------Distance from foundation__.._ g Distance to nearest lot line_________________ `�"�G' Number of pits---- •---•---•----Lining material---------•----•----•--.Size: Diameter--_-•--•------------- ' Cesspool: Distance from rjearest well-----------------Distance from foundation------------------- "-Depth____.___•._______••---- Lining material-------------------••-- ❑ Size: [Diamefer. ---1-----------------------------._.Depth-------------------- ---•-•----- 1 -- - ---______--_Li Liquid Capacity' q P tY--•----••--------•--------..gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line g g Remodeling and/or repairing (describe):___.____ F ---•-------••-----•--••----•--------- -•----••--•-•--•-----•-----------------------•------•-•---------• ------- _ '! .__..----•---••--------------------••------ ---------•------------- -------------------•---------- ------------------------•------•--------•----------•----•-----•-------•-----•---•--- I hereby certify that I have prepared this application and that the work will be done in accordance wi#h San Joaquin County r ordinances, State laws, d rules and re Mations of the San Joaquin Local Health District. (Signed).____-__ ` t _____-(Owner and/or G40mmim) r g ITitlep..li----------------- �� Plot Ian, showin Y ( P showing'size of lot, location of s ste relation to wells buildings, etc., can be laced on reverse side). A' FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY-------- -- s REVIEWED BY---------------------------------- -------------------------------------------------- `- "DATE---r$.-.b - i0_ •-- --------------------------------- DATE BUILDING PERMIT ISSUED------------------------••------------- -----•------------------••------ DATE Alterations end/or recommendations:----- ----------------------------------- .-.__.___._- • -------------•-------------..--�-. ----------------••-----•--------------------- -----•---••--------•-- FINAL INSPECTION BY:...S...... Date ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Zotll;California ?'^•;:, Manteca,California Tracy,California ES 9 AEVI5ED 8.59 ZM 5-62 ATLAS