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FOR OFFICE SE: 731 "zl !. w• `° '1 -------------------- ---------------------_.______--- ` APPLICATION FOR SANITATION PEWIT Permit No. .�.____l.l..___ ---------- (Complete in Duplicate) 04 // --------------� - --------------:.._ m Date Issued Date Issued :=-. ..[�-_3 4 - This Permit Expires ] Year From 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. A JOB ADDRESS AND OCA ON - � .-- , )1_*t, --------- --------------------- Owner's Name * - --- ---------------------- ------- - ---- i . Phone. _�--- - -- - ---•- •-•--->. -------•- ............. ------------ ----------- Address � -----••-•---- Contractor's Name----------------- ----------------- ------------------------------------ .....................................__. Phone............-...................... Installation will serve: Residence C1Apartment House ❑ Commercial Traileru ❑ Motel ❑ Other C] I Number of living units: ________ Number of bedrooms ________ Number of baths.____ o size ll.f .......____________________ Water Supply: Public system X Community system ❑ Private ❑ Depth To Water Tableft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑. Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: (If yes date--------.-----------) 'No ❑ New Construction: YesNo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic tank or cesspool permitted if ublic sewer is available within 200 feet.) i Septic Tank: Distance from nearest well --I Distance from foundation-__lJ-------!.Matyiaf--- No. of compartments--------c.p2. . ._. .Size_-3g-Ji ----V----------Liquid depth__ _ __ Capacity.... ._. Disposal Field: Distance from nearest weII_?ZG)A-_C_.Distance from foundation__�/,Of_.._._.Distance to nearest lot line-s ....... Number of lines..... _____ _ Length of each line____.3_4o_!_•___.`....__.Width of trench___�yfY__ Type of filter material.5/ _ Depth of filter material__-./- -'_-_-.Total length.......................s. ?......_.__ a Seepage Pit: Distance to nearest ell---/P� c.____Distanm f ndation___- _ Distance to nearest lot Number of pits----_7-.-__.______Lining material_ Size: Diameter.�3---__._____,Depth-----------Z--1_______________ V\ Cesspool: Distance from nearest well _____----------_Distance from foundation/---------------.Lining material-------_------------._____________._. 0 ! ❑ Size: Diameter--------------------------------------Depth----------------------------- ---- "---------Liquid Capacity............................ ) Privy: Distance from nearest well---------------------------------------._--------Distance'from nearest building___________________-_-_-____-.__.._-_--- [� Distance to nearest lot line------------------------------------------------------------------------ ----------------------- --•-•-----------------•-•--------------------- r i ,q A. Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------- ?...................:...................... # z ----------------------------------------------------------- ------------------------------------------------------------------------------•--•----------------------------------•---------------------------------------- --------------------------- -------•--------- ------ _ t I here ertif that I have prepared this application and that the work will be done in accordance with San Joaquin County o ordinance , St to s, and r41es d re �fionsofile San Joaquin Local Health District. D (Signed)------ ------------------------------ ------ --------------- -- ---- - (Ow r and/or Contractor) By:--------------------------------------------------- (Title)...... - - - -.......----------=------ (Plot plan, showing size of lot, location of system in relation #o wells, b dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED a - - --•----- - - ------•-----------•------------------ DATE.... .rte.,._ ---•-•--•- REVIEWEDBY --------------------------------------------------------- DATE------ --•---...------------------------------------ BUILDING PERMIT ISSUED------------_--------- _ DATE---------•--------•------------------------------------------ Alterations and/or recommendations:_ �__ ------ --- - -------------------------•-----•-•--------------------•---•-•------------------------- t ---------------------------------------- ----------------------------- ----------------------------------------------------------------------------------------------------•-••-•-----------------•--------------.._._.------ -------------•-------•---- ......-•----......-•--•----------------........• ----------••--- ------------------ ----- ----------------------•------------------ --------------•-------•-- --- -- -- ----- --- - -- -- ------------------ -- --- ------- - ----------------------- --- FINAL INSPECTION B •----- - --------- to --------- ------— ---------- AN JOAQUIN CAL HE H DISTRICT i 130 South American Street 300 West Oak Stre 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS