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OR OFFICE USE: / -_-- -----------#1---------::'------ -----------------• APPLICATION FOR SANITATION PERMIT Perm t-.No. _/,K-- ...-•------7 --------------------------------------------------------- (Complete in Duplicate) ------- This Permit Expires 1 Year From Date issued 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 AN LOCATION-------•• r--- - �� G-s<<f �j ,tt - Owner's Name ?.lt:�--------------- �� !") --------------- ---•--- Phone................................. +�Address._..... -- Contractor's Name.........- #� -� ------------ Phone.. Installation will serve: Residence;0"_'A partment'House ❑9 Commercial ❑ /Trailer Court El Motel [:] Other ❑ Number of living units: ]__ Namber of bedrooms _._.Number of baths ________ Lot size --------------------- Water Supply: Public system �ommunity system ❑ PrivKfe ❑ Depth ro Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑,, Sand am ❑ Clay Loam ❑ Cla [-] Adobe Hardpan C]Previous Application Made: (If yes,dote---------_---------) No Q-' New Construction: Yes'©�fVo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic,.+ank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank-j•- Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- 1 5 J -0& . of compartments---•------------------ ' Ze--------------•-------- Liquid depth--- Ca aci p ty----------------- Disposal Field: �;(:tance from nearest well._' ___..-_Distance from foundation____/AI_____.Distance to neares lot line----,�....... -9 �5 )�'S4__Number of lines." ___Length of each line----------- 0 --------Width of +ranch- -k--'---- Type of filter ma}erial_.._j!_2.-y:p_�epth of filter material..__ g __._.Total length_._...._' .�..................... . SeepageiPit' Distance tonearest well_____-' -- to from� foundation..../J;v•�_•_-.Distance to nearest lot line.... ........ r Nump ber of its_____t_ _ ___.__-_--_Lining mate ria LV_ __-Dl,4f,"_-""-Size: Diameter____- 3...........Depth___._..=. ___________ [ Cesspool: Distance from nearest well...............:.Distance from foundation-------------------.Lining material------------------------------------- 0 Size: Diameter = Depth--------------------- -------------------------------Liquid Capacity---------------------_----gals. Privy: Distance from nearest'well---------------------- ----------------------------Distance from nearest building_____. _________--_.--------------------- ❑ Distance to nearest lof line ----------- _ Remodeling and/or r s J repairing f describe=`----------- f ---------------------------- --------------------• _ ^' -------------••------------•--•---------- i a 1 "---------------"-- ---------------------------------------------------------•-----------•-•---'--------..-- -----------------------•---------•----•-------------•--.._..------...---- hereby cerfify that I have prepared this application and that the work will be done in'accordance with San Joaquin County ordinances, State la nd .rules and r u ns o the San Joaquin Local Health District'' (Signed) - -------- --"----- --------------------- ----------- Owner and/or Contractor) Br----------------------=----- ------- ----- ....... (Plc+ plan, showing size of lot, loc" ton of system to relation to wells, buildings, a c.,, can be placed on reverse side). FORDEPARTMENT USE ONLY, ' APPLICATION ACCEPTED 8Y." _. ._ __�rl _ __� "F -------------------=------------------ DATE---- REVIEWED BY------------------------------------ - = DATE BUILDING PERMIT ISSUED------------- ---------------------••------------------------- ------------------------------ DATE Alteration or recommendations:- 1- - - __—---Y-- ... - • ----------------------- ------ ------------------ - -� -..= -- -- i -----•------•--••---- ------------•----------------------------------------------•-------------------------------------------------------------.----------------------------------------• -- - FINAL INSPECTION BY:.. ' "Z----------------------•------- / SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street - 114 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 eM 5-62 ATLAS -