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FOR OFFICE USE: ----------------- -------------------------------------- APPLICATION / '7 FOR SANITATION PERMIT Permit No. ....... r./...._... (Complete in Duplicate) ld _ ______ This Permit Expires 1 Year From Date Issued Date Issued .._.___-.-../. ____ ______________ _ .7/ 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. S49. JOB ADDRESS AND LOCATION__ LL,_ _ --- _�C.___ ° _____ S�c�a. -• --- Owner's Name------� ........4----- �_ -----------------------------•-• ------------------ Phone.............� ..... �^��.. .� Address--------- --* -'c------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------•--•--- Contractor's Name__ �� ;;%partment --- .•----------•-----•------------------------- ---- Phone.__Installation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ '7 Number of living units. A.___ Number of bedrooms _-a. Number of baths __�Lot size ..___-_- ---------------------� Water Supply: Public system [I Community system ❑ Private i�r Depth To Water Table ) ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam [IClay Loam C] Clay ❑ Adobe OHardpan ; Previous Application Made: (If yes,date--------------------) No New Construction: Yes Q�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 T Distance from nearest well_________________Distance from foundation________._......._-.Material______________-...-------..._....____---____.---. No. of compartments--------------------------Size--------------------------------Liquid depth_-------------------------Capacity----------------------- Disposal F' Distance from nearest well________________Distance from foundation....................Distance to nearest lot line____----_.-----� Number of lines-----------------------------------Length of each line..---------------------------.Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material_.--..-.-----------_.--Total length....-.-.-.•-----•------------------------- F Seep go Pit: Distance to nearest well... t 6---------Distance from foundation...._C �._.___. s rice to nearest lot line....-_____�_._ ` Number of pits--------t_____________Lining material____02,4 .�___-Size: Diameter_-- P�-.______.:Depth_�"�If-_s __... 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 lotline----------------------------------------------------------------------•-----------------------------------•-----••- ------------------------ 10 M44 Remodeling and/or repairing (describe)----------- •-- 1 .......... .... -••--••-- �'.. - ------V------------------------------------- �i►=eY!----------------------------........---------------_----j 10.-�9-__J �/.l. 19-4 Pi-T---- �PF�f-•--../err-------<kN�141-t?} 101?K-0--r?� ��`> �_� ----------------------------------------------------------..------------------------------------------------------------------------------•--------------------------------- -- � herebycertify 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) --- -_- t -a-� =---------------------------- ------------- (Title) - •`"- (Plot plan, showing siz�ot, location of system in relation to wells, buildings, etc., can be placed on reverse side �- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- .!._ -------------------------------------------------------------- DATE----- �j� - .------ REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------•--------•-•---------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------••------- Alterationsand/or recommendations:----•- -------------------------- -----------------------•--------------------------.-.---------•--•-------•----------•-----------------------------_--.------ FINAL INSPEC Date. Q" -- (--- ----- = ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American$treat 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California �. ES 9 REVISED 9.59 2M 5-62 ATLAS -