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FOR OFF( E: - - ------- -- -------- .. r ............... ...___-.--------.-----.-___--.-__--__ - APPLICATION FGR SANITATION PERMIT Permit No. ..1 _._.__. ------------ ------------ --------------------- --------- (Complete in Duplicate) --------------- I This Permit Expires 1 Year From Date Issued Date Issued . 1../ � 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 ANA CAT ON-------/..• ----/-------&.,;..-_- - -_--- ------- -• Owner's Named Phone --------------------------------- Address__________________ Contractor's Name---------------- - - ------- --------------------------------------------------------------------- Phone--- .................... -••--• Installation will serve: Residence A artment House Commercial - o " Qom' p ❑ ❑ Trailer Court ❑ ;Motel []- Other ❑ Number of living units: ---?._ Number of bedrooms _,Z_ Number of baths ---/. Lot size _ � ,� - ---__----.- Water Supply: Public system PrItommunity system ❑ Private ❑ Depth To Water Table 5/4ft. Character of..soil to a depth of 3 feet: Sand ❑ Grovel ❑ Sandy Loam ❑fJClay Loam ❑ Clay El Adobe 23-11ardpan ❑ Previous Application Made: (if yes,date--------------------) No U?- New Consfructio:7,Yes,❑ No[13�- FHA/VA: Yes ❑ No g;-` . TYPE OF INSTALLATION AND SPECIFICATIONS: "� `. V (No septic tank or cesspoo'Lpermitted*if=public sewer is available wi+hin 200 feet.) .k Septic Tank: Distance from nearest well--f!r._--Distance from foundation_.. _. ------- 'F L 6l !/ r� r l! [� k No. of compartments-------15_+------------- -Size- - --X_ Q-._--Liquid'depth-.- -----------Capacity._rP,0_A* .--- Disposal Field: Distance from nearest well ---------------i Distance from foundation-----_-_----_-_-Distance to nearest lot line---_._......_._.. ❑ Number of lines-----------------------------------Length of each line----•-------------•--It------Width of trench-------._------__-----_----__--- Type of filter material-------------------------Depth of filter _ material_. ____----_ ,._...Total length------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-----.------__--_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------ ..................Depth-----------------------------...- Cesspool: Distance from nearest well-----------------Distance from foundation___r/-----------"*,Dining material-,----------------------------------- ii,❑ Size: Diameter--------------------------------------Depth...'11_x--------,----;--------•-----------------------Liquid Capacity---------- gals. Privy: Distance from nearest well-------------------------------------------"-_Distance from'`ea,est building_- ---------------•-----------•---__---- .. .� Distance to nearest lot line : ` 3r=- ------------------------------------------ 09A, `-•==--------------------------------- F f Remodeling and/or repairing (describe): `r% ----- -----------------------•- ------------ f i ! - - a_._ „ _ -.. ------------ ---- ------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------...._____.._______..__.__..___.._ . 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 ules and regulations of the San Joaquin Local Health District. 1 (Signed)-------------------- •-•---- ----_----- --- " ` (G*ner+eed�or Contractor) ---- -- t By: ---- _,(Title) "11 �' ---------- € ---- - ---- JPlot plan, showing size of lot. location of system i ela�wno wells,.buildings, etc., can,be placed on reverse side). R DEPARTMENT USEONL'Y i APPLICATION ACCEPTED BY --- DATE_...- / REVIEWEDBY------------------------•----------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED-------------------------------------------------------------------- ---------------------------— DATE Alterations and/or --------. -•--------- --------- ------------------ FINAL INSPECTION BY:-----------e ------------• --------------- Date----------` = .- ---------------------- SAN -----•---•----------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street t Stockton,California Lodi,California Manteca,California Tracy,Californlo i ES 9 REVISED 8-59 2M 5-62 ATLAS