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FOR OFFICE USE: _.._.stC.l".� �_ `_ ___ APPLICATION FOR SANITATION PERMIT Permit No. ./....z J ------------------------------------------------- (Complete in Duplicate) gt/ y --------------------------- I This Permit Expires 1 Year From Date Issued Date Issued ...... .rl.. .... 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. qp JOB ADDRESS AND LO AT / ---- A.. � G�r� LY--.- _ Owner's Name.......... ..... --- Phone.................................... Address............. _. r_._.... "` ------... _......--------.....--•-•-••--- Contractor's Name............... ... . 1�_____. Phone.. --------------------- ------- -----•-- • ................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .- _. Number of bedrooms . _ Number of baths _f___ Lot size A%__Ale. .............................. Water Supply: Public system Community system ElPrivate ❑ Depth to Water Table _ .P41 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 FIr" New Construction: Yes J20"No ❑ FHA/VA: Yes ❑ No Pg--- 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 foundation __ .f___.Material___�� . 93eNo. of compartments---_._.�__.________--Size_%`��°-��. _`'__.Liquid,depth_:...!,��-----__-_--Capacity..... ..... Disposal Field: Distance from neatest well Distance from foundation tle.......Distance to nearest lot line t.�_........ Number of lines.__ -.1-`� .__-__.___ _Length of each line... '�f... �' Width of trench..•7._.._--. .--•_----..--.-•-- Type of filter materia . Depth of filter material----f�--------Total length.....TIO-------------------•...--•- \ Seepage Pit: Distance to nearest well---_---_^-----------Distance from foundation...AP.........Distance to nearest lot line..00 . ..... [L]� Number of pits......./------------Lining material._XQ�oe__Size: Diameter__r�?".: .......Depth_.. '............... Cesspool: Distance from nearest well.................Distance from foundation.___.-.____-.-.-_-.Lining material............................ \X ❑ Size: Diameter--------------------------- ----------Depth------------------------------------------------------Liquid Capacity............................ gals. V Privy: Distance from nearest well----------------------------------------- -:--_Distancetfrom nearest building___..:_........................................... ❑ Distance to nearest lot line----------------------------------------------------------------------...............................---------------------------- 74 Remodeling and/or repairing describe ______________ ._.--•.--.-•...-•..--.___...-•.---.••••-••---- ...............................................................•.......................................................................................7----•-----•-•-•--•-•-------.------------------_--------------=------- --.-•-••-_.--.•---.----..--•-.-•..-•---•---•--•--------•--•.•------------------------------•-•-•--••---•-.••--•-•.••-•---•--------••••------------_---------•---.-•----.--••••-----•--•_--•••...--..••.--•--•.------.-- I 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 and regulations of the San Joaquin Local Health District. (Signed) '" ----------- Contractor) ---- By:.......................................................... ------------------- .........(Title)... '---------------------.-...-- ------ (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ............................................... .� --------- DATE-• ---�-----4---------�=--------------------------- REVIEWEDBY---------------------------------------- ----------------------------------------------------------------------------- DATE-------------------•------------------------•-••-••-••--•--- BUILDINGPERMIT ISSUED----------•-------------------------------------------------------------------------------------••-• DATE............................................................. Alterations and/or recomm dations_______________ r _ �s'-•--�'--"--�-�-----'---/-- ----- --.:.��-tom - - ----- --_---=--- - ----------c./�.-- --- ---..... -•------ - ....�.7.-.................... ................................................................................................................................................ .... _................................................................... -----------------------------------------•----------•--•----- •--••-..... ----------------------------•------ ------ ......................................................................................................................................................................... FINAL INSPECTION BY:------✓.�_... Dete r— '?---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stroll 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5.59 2M 5-61 ATLAS