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FOR OFFICE USE: t�' P _________________________________________________________ PLICPermit No.ATION FOR SANITATION PERMIT ---..-....... -'�------- (Complete in Duplicate) / ----------------- --- This Permit Expires 1 Year From Date Issued Date Issued .... . L 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. ,�,L�. JOB ADDRESS AND LOCATION.. h2 711Z"- 3 Owner's Name...... --- ----•---- ------------- -------------------------------------------- Phone... ............... Address........./IF A ..-.......4=11, Contractor's Name . •. --.. •--... ..---�---�-------- ------- Phone Installation will serve: Residence`s Apartf ernt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ..----- Number of bedrooms ..Number of baths -.1_.... Lot size ........� ...... ................ Water Supply: Public system [:] Community system [:1Private �fl Depth To Water Table/15"—ft. 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 K New Construction: Yes No ❑ FHA/VA: Yes ❑ NOW 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----sk!.O-----Distance from foundation----dQMaterial.... Liquid of compartments------------- -----.-Size. ___ .-. -. 19_x... Disposal Field: Distance from nearest well---6_0-------Distance from foundations.._7P.......Distance to nearest Ipt line-.La .. Number of lines----/--------- -- ---J Length of each line....75-------------f-----Width of trench------ .f------------ Type of filter material.-51 .-_-.-�' __'-_Depth of filter material..._ ...2----------..Total length---------7-.......................... Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth................................. Cesspool: Distance from nearest well-----------------Distance from foundation__.____.....--_--..Lining material..--.........--......--.............. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------.Liquid Capacity.........................•--gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building...--...-..----------------------.-----.-. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):--------- --------------=-------------------•-----------•----•-•--•-•-------•------•----•-•-•-•-----•-•--•---•-----•--------•--•-----•-•......---•--•---• n --------•-----------------------•-----------------•-----------•----------------------••---•-•-----------------•-------••-•------------------------- -•-•--•-----------------•............................................ 'f -------------------------------------------------------- ---------------------------------------------------------•---------------------------.------------------------.--------------.-------.-----------.----------... ----------------- •----------•------------------- -----------------•---------------------------------------------------------------------------------•----------------------------------------.------.-•--•---------- ------ 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. .._._Owner and/or 17 (Signed) dl 12�G �j-------�?'---, . 4' ti ( / Contractor) r A, BY:----------- - - - --------------------------------------------•----------••------•---.Title ( ) - (Plot plan, showing size of lot, 1'ocat on of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------- ----------------------------------------------------------------------------------- DATE--------------............................................. REVIEWEDBY--------------------------------------------- -------------------------- --- ---------- --------------------••-- DATE---•---- -- --- BUILDING PERMIT ISSUED----------------------- •------------•--- - DATE ----------------------------------------------------------- Alterations and/or recommendations--------------------------------------- ------ ----------------------------------------------- .............................................................. --------------------------------------------------------------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------- ---------•----•-------------------- ----------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------- --------------------------------------- ------------ ----- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ........................................ ----------------------- ----- ---- ------- -----------------------------------------------------..------...--------------------------------------------..... FINAL INSPECTION BY:...... .. -------------- Date------..... - .---._1.�....... .. ----_--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak Street 124 Sycamore Street 205 Wort 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS