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FOR. OFFICE USE: ---------------------- ------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ._..l. .J�..!�_� ............ -- - -------------------------------------- (Complete in Duplicate) _ ------------------- This Permit Expires i Year From Date Issued 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 Ordinance No. 549. JOB ADDRESS AND LOCATION...,, a� _tf_._.. ------------ 'U !.� Owner's Name------ 1-••------ ------------------------- - --------------------------------------••---------------•--- Phone_....•---•-----•----- - --------••--•-• Address..._,�-s &�5- ----- s�= ✓�= L Contractors Name-------A—1.0_-f�_!ft/sS o._, --=�•G //rte: ?_3--------- ------- Residence ------•---•-- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ________ Number of bedrooms ________ Number of baths _ Lot size _____A__ X_ - U Water Supply: Public system a Community system ❑ Private ❑ Depth To Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [j Adobe, -' Hardpan ❑ Previous Application Made: (If yes,date--------------------) Nog New Construction: Yes`1 No E] FHA/VA: Yes ❑ No El 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____Z _____Distance from foundation--.-._/-0__ Mate�ai__� 'LC ............... Disposal Field: Detente fromnearest we]----j-_jj' pr � Size__llX=`� ----- ---------Liquid depth---- /__ ___________Capacity..../�f�� _____Distance from foundation-_-_--- ---------Distance to nearest lot line.-_,�T......... Number of lines------------/_-``-�-----------------Length of each line---------- --f�--------..Width of trench.-__. _�___________._____---•-- Type of filter materiaL___�C(¢4'_l ------Depth of filter material_____ _____________Total length______-1'.Q._........._._.._.......____ `l1 Seepage Pit: Distance to nearest well----/�U_/------Distance from foundation....�Q......._..Distance to nearest lot line..... R�r Number of pits----.-/--------------Lining material--- �f1:<_1�----Size: Diameter-= �--- ��Z-Depth------Z_'s-7----------- 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 rep •jQg (describe):-------------------------------------------------------- - -----------------•-----------•-----............... -•-------- ------`- ---------- =-----------"`----------------_---U•• ---------•----------- \. -----------------------------•-------------------------------------------- --------------------------------- ----•------------------------•-------••----------------••------------•--------- - ------••----•-------------- 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)------------------------ ------------- ------------------------ - (Owner and/or Contractor) (Plot plan, showing size of lot, lac "anon of system lr relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ ___ -___r5' __(- --- -_c--------------------------------------------------------- DATE-------��-�^-�'°r---J-- -- - ------------------- REVIEWEDBY----------------------------------- -------- ------ DATE_-------------------•------------------------------------- BUILDINGPERMIT ISSUED••••...-•-------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterafions and/or recommendations:-- -- ':J_:.1 .......... ...... ........... • ---------------------------------------------------•--••--••--•---••--•--••---•-----------...-.....---...--------•- ---------------------•-•----•-••--•----•------- -----• ---- ---•--------------------• ---------•----------------------------•--•-----•----------•----•---------------------------•-------------......••-•----------------- ----------------------••-----------------------------------•--------------------------------------------------------------------------------------------------------------...---------•---• ---------------------------------- ---•-------------------------- ----------------` ------------------------------------------------_------------------------ ------------- ---------- ------------------------------- FINAL. INSPECTION BY:...... Date -/�- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stmt 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Locil,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS :� •+�}.,