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FOR OFFIC USE: 4`0i 2 ------ -1—` '�J PPLICATION FOR SANITATION PERMIT Permit No. .1... ------------------------------------------------ ------- (Complete in Duplicate)u licate ( P P• ) Date Issued .�..__�............. ------------------_-----___--------___---------------- This Permit Expires 1 Year From Date Issued 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 Qrdinan o. 549 JOB ADDRESS AND CATIO ...../ - � ` Owner's Name---�-•y•- . . ....---- Phone.................................... Address.....ls—6-- ` Contractor's Name____________ _ .._..._.._....__ .. Phone................ ------------------------------------------------------------•---------------...._. ...........-------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ s � `y Number of living units: .__.. Number of bedrooms �. Number of baths /.... Lot size _440,<--.IA407.....................11 Water Supply: Public system Community system ❑. Private❑ Depth To Water Table 4110. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam'[] Clay Loam ❑ Clay ❑ Adobe e"Aardpan ❑ Previous Application Made: (If yes,date--_----------------) No New Construction: Yes ❑ No L&-'FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,�_Ze tic Tan Distance from nearest well_________________Distance from foundation....................Material................................................. Y I-`rJ;� No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- DDisposal- Distance from nearest well-- Distance from foundation...IQ.........Distance to nearest lot line.a3_... ... Number of lines______` __�__,__j.�Length of each line..��............:Width of trench--- --_--___-____-_-__---__ Type of filter material.4y -Depth of filter material.._. _ pp�� -Total length--- _ Seepage Piet: Distance to nearest well.-----_______---------Distance fr m fo ndation-_.-.2t_tO..._..Dist nce to nearest'lot line__- .._..__.. Number of pits------/.-_________Lining material._.��Q�, _-Size: Diameter__.99�-------Depth...,2.�'................ Aest l Distance from nearest well_________________Distance from foundation__:-_--_____-_.-.._.Lining material..................................... ❑ Size: Diameter--=------------------------------=----Depth----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well________________________________________________Distance from nearest building________________-__--_------_--_-_-_-_-.-. p Distance to nearest lot line----- -----------------------------------------------------------------------------------------•----------------------- Remodeling and/or repairing (describe): ---------------_-------........................................................ ------•-•--------------------•-------•---------•-----•-------•-----------------•----------•-------------------•--------------- --------•--•--•------•------•------•-••---••---•-•-••---------•--------•----- ------•----------------------------- -----••--•-------------•---------•---------------------------------••-------•------•-----------------•-----------------••-----•--------•---•-----------•----•------------------------- 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).......................... / -- ---- ----------------- --- - --- ---( r Contractor) By:------------------------ ----• Title).....-- i�,l ,/Ll'--------.--..--- --------- (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----j----<---- B"----------- ------------------------------------------------- DATE..../�... --1-6----T----&-�--------- REVIEWEDBY---------------------------------------------— --------------------------------------------------------------------------- DATE........................................................... BUILDING PERMIT ISSUED--------- -- -----------------------...................................... DATE............................................................. Alterations and/or recomme dations---------------------------------------- -- --- •-- --------- ----------•- ------• - ------- --- -- ---------- ------------------------------------ ---------------- ------------------------------------- -------------- ----------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.- -------------------- Date` Cl��: ---- --------------------------------------------------- SAN '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 5-62 ATLAS