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FOR O F U$E: ------------------ -------- -- g__..._/.{._ S APPLICATION FOR SANITATION PERMIT Permit No. .. ../ . . ------------------ -------- Date Issued --------------------- (Complete in Duplicate) . ....................1 / 2 --- - ---------------- ----- `----- _______________ _____ This Permit Expires 1 Year From Date Issued G _ 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. Q JOB ADDRESS AN -- 1 - - (10 IS _1 Owner's ....---Y ---------------------................................................... Phone.................... ....... Address----------• / - n__------------ 'lZ ............................................ Contractor's Name-s= ----� T___3................................................................................................. Phone...........................-----... Installation will serve: Residence Z3'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: .-I Number of bedrooms __2_. Number of baths ).... Lot size ... f' ./__ Gf�.............................. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .Sp ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] lay❑ Adobe Q--i-Fardpan ❑ Previous Application Made: (If yes,date---------------.----) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SA tic T k: Distance from nearest well -_ _..Distance from foundation__��________:M terial.. ............................................. f t e No. of compartments_ — Size------ �T__.Liquid depth___fy��_/-------------Capacity._,,?._6? .q.e Disposal Field: Distance from nearest well. Distance from foundation..../Q!....1 .......Distance to nearest lot line................. Number of lines___________ _____________________Lengtt of each line........q .............Width of trench............Z.SL.---.-_-------- Type of filter material._. __ .......Depth of filter material----Lr-__..........Total length............`10. ................... 11 Seepage Pit: Distance to nearest well----!--..........Distance from foundation_-0ein—..Distance to nearest lot line. Number of pits.........I-----------Lining material_'l_l K__�_____..Size: Diameter-----�-'�..............Depth......4�-................ Cesspool: Distance from nearest well•----------------Distance from foundation---.--_-____-.--_-..Lining material..................................... ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. O Privy: Distance from nearest well------------- ---------------------------_-------Distance from nearest building-____-_-_______-____-_----------•---___-_. O ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------ l Remodelingand/or repairing (describe):--------------------------------------------------•--------------------------------------------........................................................ .............................................................--------------------------------------------------------------------------------------------------------------------•--•---•--•------------ ............. ......................................................................................---------------------------------------------------------•------------------------------------.....---•------------------------------- ............................................................-----------------------------------------------------------------------------------------------------------------------------------------------------..........--- 1 hereby certify that I have prepared thisyapplica4iond that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulatiJoe in Local Health District. (Signed)•-------•------------------------------------•------------------- ----------------------------------------•--------.......(Owner and/or Contractor) By:-••--------•------•-•-------------•---•-----------•-•--- -------- ---------------------(Title)------•----------------------------------------- -------------- (Plot plan, showing size of lot, location eo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION .....................................ACCEPTED BY__LZ___' _- ""--------------------------------- --- DATE--- ------------- , - REVIEWBY --------- ----------------------------------------------------------------------- DATE..............................................------------BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE............................................................. Alteration and/o recommendations:. ---- -------------------------------------------------------------- - ------------------•--------------------------- ---------- - ------------------ ------------------- -- ---------------------------------------------------------•-------------------------. ---------------.---..................................................................................................................... ........................................................ ------ - - ----------------------------------------------------------------------•-------------...-----------•-----------•-•-•••----•-----...--•--.•--•- FINAL INSPECTION BY--- -------- --- -------------------0 --------------------- Date----------- .1�.3...-_....------------------------ 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 8-59 2M 5-61 ATLAS f`