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FOR OFFICE USE.. ------------ APPLICATION FOR SANITATION PERMIT Permit No. ---------------------- (Complete in Duplicate) Date issued This PermitExpires I Year From Date Issued --------------- ------------------ -A 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. 4 ------ JOB ADDRESS AUQ LOCATION.). --el' �.9--------------- - ----------------------------- -------------------------------------- -------- ----- Phone----------•------------•------------ Owner's Name----- Address--•--_------------------ ame----- Address--_-_------------------ ---- 7 -7 - ------------ ------------------- -- - -------------- - ------------------ Contractor's Name.. - l - , m. _ - ---------------- - ❑ Installation will serve: Residenceeouse ECommercial E] Trailer Court [I Motel 0 Other ------ Number of living units: Number of bedrooms _-Z Number of baths --/-. Lot size ------------ Water Supply: Public system Community system 0 Private E] Depth i-o Water Table -------- ft. Character of soil to a depth of 3 feet: Sand 0 Gravel Cj Sandy Loam [I Clay Loam [3 Clay 0 Adobe A Hardpan C] Previous Application Made: (if yes,date--------------- No J& New Construction: Yes 0 No ❑ FHA/VA- Yes ❑ No.� 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__%57�2_'___Dista6ce from foundation---lq!...... ...................... .-- - .- ..'5— - _A5�r_.eAf_4._ No. of compari.ments--------J--------------- a.--.Liquid depth-- ----------------- -capacity/ m foundation---el .......Distance to nearest lot Distance from nearest well-urU.......Distance from Disposal Field: -le --------------- Number of line ----------1-7------ -4-AN Length of each line-----!;E!5F --- ---------Width of french. N ;: _�; erial--ZR...........Total length------- _;W---------------- Type of filter material—e'(---- t---Depth of filter mat Seepage Pit: Distance to nearest well-_14:e) ... Distance to nearest lot line--- U', -----------Distance from fpundafion---Z�. ....... Number of pits------sX-----------Lining material.-A __Size: Diameter----- Depth---y--------------------- Distance from foundation.-_-- ------------- Lin.ing material_____________________________________ Cesspool: Distance from nearest well___________----- NO -------gals. Size: Diamete�--------------------------------------Depth----------------------------------------------=-----Liquid Liquid Capacity-.------------------ El Privy: Distance from nearest well--------------- ---------------------------------Distance from nearest building-_------_____-______------____-__-_-__..-. ❑ Distance uilding-------------------------------------- Distance to nearest lot line- ------------------------ - - -------------•---------------------------------------------------------------- Remodeling and/or repairing (describe):__ --------------- ... —------------------------------ ------------------------------------------- ------------------------ ................--------- ---------------------11--------------- ------------------------------------------------------------------------------------------------------------------------ ------------------ --------------------------------------------- ------------------------------------ ------------------------------------ ---------------------------------------:-------------------------------------------------------------------------------- ------------------------------------------------------------ I hereby ceff I ify4at'l 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)________-- ---------i------------------------------- ------------------------_--------------------------(Owner and/or Contractor) if IS) .................IT ...... .......... ------ By----------- —----------------------------------- --------------0 -- --------------- _�e ------ (Plot plan, showing size of lot, location o s Ks relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------- DATE----- -------------------------- -- APPLICATION ACCEPTED B - - ---- --- ---- --------------- - y ------------ DATE---------•-•---- ---------------------------------------- RJEViEWEQ BY--------------------------- ------------- --------------------------------- -------------------------- ---------- DATE.----------------------------------------------------- BUILDING PERMIT ISSUED-----------------------_- --------- - -------------- Alterations and/or recommendations:.... ---------- --- -- -------2�a------- o.-/..... - ----- ----------------- -------- ----------------------------------------------------------*----------------------------------------- -----------------_- /----------------------------- - --------/- - ------------- - -------------A --------------------------------- -------�_. ---------11-1------------------------------------------------------ ---------------------------------------------------------- -------------------------- -------- ------------- ------------------ ---------------------------------------------- ------------------------------------ ---------------------------------------------------- ----------------- ---------------------------------- -- ----- - - ----------------------- -------------------------------------- ----------------- ----------_ ---------- Date------------ -------------- - --- ------------------------------ BY. L! -.-- .- FINAL INSPECTION ...... _ . .. .... - ----- (1; 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 rye r+ 1l ES 9 REVISED 8-59 2M 5-62 ATLAS 3