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FORPFFICE USE. APPLICATION FOR SANITATION PERMIT Permit No. -- ---- ------- ---------- W (Complete in Duplicate) Date Issued ---- ------------------ ---- ---- - This Permit Expires I Year 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 WNNo. 49. JOB ADDRESS AND LOCATION---- ll. --•-- ........------------ ------------------------ ........................................ Owner's Name -- ----------- -------------------------------------------- Phone......------ ' hone............ ---------------- Address--------- ------------------------------------------------------------------- ---------------------------------------------------- Contractor's Name---------Z&.....3----TA---------- --------------------------------------------------------------.................--- Phone----------------------------------- Installation will serve: Residence 0- Apartment House [:] Commercial [-] Trailer Court E] Motel [I Other E] Number of living units: .-_-I--- Number of bedrooms .;2=-- Number of baths _1-- Lot size ----------------------------- Water Supply: Public system [community system El Private I-] Depth TO Water Table rJ ft. Character of soil to a depth of 3 feet- Sand E] Gravel [] Sandy Loam 0 Clay Loam [D Clay E] Adobe E]-' Hardpan ❑ Previous Application Made: (if yes,dote____________________) No [v' New Construction: Yes Ej-,-No E] FHA/VA-. Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic a -------- -- ------- ----------------------- ------ Sep nk: Distance from nearest well--- ------Distance from foundation-/-e... Material---_ No, of compartments______,_'2-------- -----Size---- .....Liquid depth......4-- ---_---_--.-_Ca pacity--- - 7 Disposal Field- Distance from nearest well____`-.--- --------Distance from foundafion_/_C............Distance to nearest lot line-_r.4=....... Ur Number of lines.... ---------------------------.-Length of each line--------20.. ............Width of trench -'1- 4 -, Type of filter maferial.77fix-k -- - -- --------Depth of filter material----U-----------------Total length____,X -1------- b See Pit: Distance to nearest well------—-------------Distance from foundation-__1 __._.....Distance to nearest lot line--' ---------- Number of pits.-.I-----------------Lining material._'_,t3(1.(,A......Size: Diameter------3_7_' ----Depth------2.,,r--------------------- Cesspool: Distance from nearest well-----------------Distance from foundation'_----------------Lining material-------------------------------- .... E-1 Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity----_----------------------gals. Privy: Distance from nearest well..............._____-_______._____-.-_.----Distance from nearest building----__-_.-._.__----_-----_--` `r__ ❑ Distance uilding---------------------------- Distance to nearest [of line----=---------------------------- ------------------------------------- 4 ��w.-rVe I Remodeling and/or repairing (describe)------------------- .......................--------------- ---------------------------------------- ------------------------------------------------------------------------------------------------1___.------------------------------------------------------------------- --------------------------------r------------------- ---------------------------------------------------------------------------------------.----------------------------•--••-•-•----------------------------------------------•------------------------------------------- ------------------------------ ----------------------------- ----------------------------------I-------------------------------------- % ---------------------------------------------------------- ---------------- Fhereby certify that I have prepared this applicafi n and that the work will 66 done in accordance with San Joaquin County 0 T ""T' ordinances, State laws, and rules and regulation of f San Joaquin Local Health'District. (Signed)----------------------- -----__----- -- ----------- --- --- -------- ------- - - - --------------------------------------(Owner and/or Contractor) By:-.--------------- ------------ - - ----------------------- ----------------------------------------(Title)---------------------------------------------- ------- --------- +0 f s m (Plot plan, showing size of lot, location of sys em,in relat' n,to.weIIs,,buildings, etc., can be placed on reverse side). FOR DARTMENT USE ONLY APPLICATION ACCEPTED -7- ----------------------- -------- DATE_ REVIEWED BY-------------------------------------- --------- ---------I I ----------- --=--------------- -------------------------- DATE--------------------- BUILDINGPERMIT ISSUED------------------------------------ ------------ ......-------------- ------------------_DATE------------------------------------------------ Merations and/or recorn mendaf ions:_,'. "- --------- ............... ------ ---------- _ ----------- =-"- - -- ---- ----- -- --------------......... ---- ------- ................. ----------------------------------------------------------------------------- ------------------------------ ------------------------------------------------------------------------------I----------------------------------- ------------I---------------------------------------------I-------------- ------------------------------------------------- ------------------I---------- ---------------------------------------------- ------------------I-------------------------------------------------------------•--------------- 9 ---------------------------- ---------------- FINAL INSPECTION BY:...---- —----------- Date----------- SIN JOAQUI'N LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak Street 124 Sycamore$frost 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS