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FOR OFFIC USE: ; x APPLICATION FOR SANITATION PERMIT Permit No. ..,l. . --------------•----------- --------`--------------------- (Complete in Duplicate) 4 ( Date Issued ._��.__ ..___ ------------------------------------------- -------- This Permit Expires 1 Ycar From 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 L CATION•--_--1-i_- 4- -----/4-._-_-_ = ---------------------------------------------------•------------------- Owner's Name. ` -- Phone....-----•-•--------------------- f Ad d ress----------------= ------------------------------------------................................ Contractor's Name....- -.....__--9 . - Phone ... - � Installation will serve: Residence Apartment House ❑ Commercial [3 Trailer Court F1 Motel [3 Other ❑ Number of living units: .- __-_ Number of bedrooms C;;2— Number of baths --/-. Lot size ----�_�._�_; /...�Q-0 Supply: Public system? Community system i[] Private ❑ Depth TO Water Table'Z ft.I It I Character of soil to a'.depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe.` Hardpan ❑ Previous Application Made: (If yes,date--------------------I No ❑ New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) } tit Distance from nearest well-------------- --Distance from foundation-------------------.Material--------------------_--- ----.-.._----_.------..- No. of compartments---------------------.-�--Size___-_-_--_-_-_.-._----.----_,.._Liquid de th-_-_--------.------_:---.-Ca aci __-___ i Distance from nearest well.-I------.--`--Distance from foundation....................Distance to nearest lot 4line................. Number of lines-----------------------------------Length of each line----__-_-.-.---..---_-.-....Width of trench.... ..........---.--_.---......- \ Type of filter material----------------------1--Depth of filter material-----------------------Total length.......................................... e Distance to nearest well t�Distance f fou clation___ .Q_�_-_.D' tante fa nearest lot line__---- to f Number of Its------ ---------------Linin t 'r Pits g;material-__ - --- ¢e:.Diameter---- .---...__.,Depth----a2-,$-.................. Cesspool: Distance from nearest well-----------------Distance from foundation---.---------------.Lining material------------------------------------- 11 Size: Diameter--------------------------------------Depth--------------------------------------------------.-Liquid Capacity---------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------.-.---_----__---_---___----..----.-. ❑ Distance to nearest lot line------------••--•-------------------------------•--------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------- ------------------------------•-•-.....................--'--.....................•------............•-------....-----._.-.-....-. I ----------------------------------------------•------------------------------•-------------------------------------------------------------------------------------------------------------....------------------------------- --------------------------•--------------------------------.---------------.---••-•------------------------•-- ------------------------•-----............----------------------------•----- ----•------------------ . . . f I hereby, ce ' that I have pFepared this application and that the work will be done in accordance with San Joaquin County ordinances, St ws, and r les and'reg lafions of the San Joaquin Local Health District. k [Signed}------- - -----------------------------� ` ner and/or Contractor By:-------------------------------- ---- --- ----- -- -----------------------------------------------------(Title)-------- --e---------------------- ----- --.----..--------- (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be'placed on reverse side}. 'FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - •---------------•---• DATE---- -•---• - ----- ----------- REVIEWEDBY-------------------------------------------------- - ----``----•-----------------------------•............................ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------•-••-•---------------------------------------- DATE-------------_--------------------------------------------- Alferat' ns and/or recd m n on _''_---------------- -------------- ....._-- , _ .._ ----- --------------------------------------- _-. ----•-- � ,- ��.-� - ---------- L.....- - - 2-r--�--- -•r �-. -- - - - - . �-•--. _ - ._ ---� ---___ "cry. _ r.-- -- -------------------------------------------------------------------•`-`----.--.--------.----.--.-----..------.--_---..-_-----------------•-----------... ....__.........----•------------I---•----•---•--------- ......... ?1 - FINAL INSPECTION BY:-----� - ------ - Date.------ L ��----�-s-------------------------------•--- SAN�JOAACQUIN 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 ES 9 REVISED $-59 2M 5-62 ATLAS