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---------------------- ------- {_ _f__- APPLICATION FOR SANITATION PERMIT Permit No. ____ ............. ----------------------------------------- - ------------ (Complete in Duplicate) 4/ / - This Permit Expires 1 Year From Date Issued Date Issued ........��C..��. - 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. yy JOB ADDRESS AND�L)O TION-- Owner's Name Lsf.� (!L�- - - - - •---•------------------•------------------•--•---•--------------••-•---------------••------•----. Phone....... Address ' �= ------•---••-------------•---------------------------------------------•-•--•----••--•---...--------•----------•-•-•---- ------- Contractor's Name______ y� Phone____....__._.....,. ---•---•................ •------------- Installation will serve: Residence ggo-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .____ Number of bedrooms .2-__ Number of baths ._f.. Lot size .............................. Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 40 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 Uge' New Construction: Yes ❑ No grFHA/VA: Yes ❑ No Eq-' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tan's: Distance from nearest well_________________Distance from foundation....................Material................................................. rug 15y'!.� No. of compartments-----------------------: Size--------------------------------Liquid depth--------------------------Capacity--------•--•......--•-- isposal Distance from nearest well______0....Distance from foundation--------------------Distance to nearest lot line................. Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material=___'--________________Total length---_•..____________-___.......... ...__ ,{ / LLam/ • Seepage Pit: Distance to nearest well-----'__________Distance from f undation___!7 _._.___.D'str a to nearest lot,tline___e _.___.- Number of pits---.l________________Lining material_ ___Size: Diameter-_�.�_-.-------Depth__° _e!_-Z_...______....._. 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 ---------- Remodeling and/or repairing (describe):---------- --------•--- --- --• -----------------------------------------I.................... ---------------------------------------------•---•--------------•-------------------------•------•---•---•--------•-•--------•-----•--------------------------------------------••-------------------------•-- ......... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law"andules and reg lations of the San Joaquin Local Health District. (Signed)............. ( r Contractor 1 By:--------------................................ ........ -------------------------------------(Title).-�,�,------------------------------------ -- (Plot plan, showing size of lot, location of sy �in relation.to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- r ----------------------------------------------------------- DATE----�-- 1 `' 2 REVIEWEDBY ------•l ...__._------------ ---------------------------------------------------------- DATE_-.---------------------------•---••----------------------- BUILDINGPERMIT ISSUED----------------------------.---------------------------------___. ----------------------------------- DATE--•-----------------------------------•--------------------- Alfer tions and/or recommen ations:_________________ ___ _�___.-.______._.____. ___ 1� 2 . -----------------`�------fir � � ............ "I....1 •••- - "I.....- z -------------------------------------------------- ------------------• - ---------••-- -----•----••.............. FINAL INSPECTION BY: - = <_ Date=„ ----------- - ------------------ AN JOAQUIN. ° AliAHEALTH DISTRICT�`� 130 South American Street 300 West Oak Street ;�' 's a� —124 Sycamore Stfeet 205 West 911h Strout Stockton,California Lodi,California s, Manteca,California Tracy,California ES 9 REVISED 0-59 8M 6-61 ATLAS '