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---------------FOR OFFICE USE: - 1-4�_ � ..� ---------- ----------- ---------.._.---__�__ APPLICATION FOR SANITATION PERMIT Permit No. ..,! � ---------------------•------------------------------- --- (Complete in Duplicate) %� -------------------------------------- This Permit-Expires 1 Year From Date Issued Date Issued ._____--Z9... � Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and 'nstall the work herein descrbed. This application is made in compliance with County /Ordinance No. 549. JOB ADDRESS AN L ION "....- Owner's Name-- --•-- -------- --Z -- ----- - -- ----------- ................... ------ Ph on -- f_ Address-----------_-- _- ---- - - ----- !- --- Contractor's Na' e----------- ` � --- s F_ _�_.�_ 1. Phon ...... Installation will serve: Residence Apar ment House Commercial ❑ Trailer Court [3 Motel ❑ Other ❑ Number of living units: N mbar of bedrooms __a�Iumber of baths _/___ Lot size __ ------ ._ _ ! Water Supply: Public system Community system E] Private E] Depth To Water Table - t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe ardpan ❑ Previous Application Made: {1f yes,date--------------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS——..t– :,- (No - t.- (No septic tank or cesspool permitted if,public'iewer is available within 2_00 feet.) Ir a ' t Distance fromY nearest well_f,f`.........Distance from foundation.___.�-------------Material-________._____.___--________------..._______--.. No. of compartments -- ----------Size-------•---•----•---------- --•Liquid dept-------------------------Capacity._.....---------------- os _... =i os a Distance from neares -,well...4014e_Distance from foundation-a.��_ _.Distance to nearest lot line...... .... Number of lines._.__._.. ___ �._._ - Length of each line__ t _ -----------.Width of trench------a�_ __________._ Type of filter materi `�-�' � YP - __Depth of filter materia_.__ -----Total length.......�fi1___________________- e P t Seepage Pit: Distance to ea� s well_..nf___. ___-_Distanc��om foundation_CZ,,Q____Distance to nearest lot line__ - Number of pits_--/_________Lining material__] �-�------Size: Diameter__�o_.rL------Depth___c Cesspool: I Distance from nearest well--______________Distance from.foundation--------------------Lining material--------------.________________----•- ❑ Size: Diameter----•----------- --------- -- -------De Dept =---.. -----------------------Liquid Capacity - P � ..M _ --------- 9 ---------------•-- -------..gals. Privy: Distance from nearest we'll__----------- '--_---__---____._._____-_.-----Distance from nearest building--------------------------------.-._.-.__. ❑ Distance to nearest lot line. -------------------------------------------------------------- --- •---•----------------•--------------..-....-------------- Remodeling and/or repairing (describe):----------- -------------------------------- -------------•--:..--- -- ----•-- -----•-------• --•---------•-•---------•--•---- -•----•--------------------------------------------- --------•- - L ,. ,..�.....- - ------------------------------------------------------ -------- .-•--- r r ---------------------------•----- - ----- -- I hereby certify that I ve prepared this ap lication and that the wo will be done in accordance with San Joaquin County ordinances, ules and regulations oft an Joaquin Loc alth District. (Signed) ` -1------------ ------------------ r ontractor) BY: - y---------(Title) ' (Plot plan, showing size of lot, location of system in t ells, buildi s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- + -------------------------------------------- DATE..------�� y 1 ... REVIEWEDBY---------------------------------f----------------------------------------------------------------------------------------- DATE-_------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- D,4TE. Alterations and/or recd menclatia --_-- - -•------------------------•_-•-----------------••-•-•- ------- -' r .. -- __A- ----,1-est--- - = C� ��---- �• �. -- ------ ------ =---------------------------------------------•-------------------------------------- ----------------.....------------------•-------------------- -•--•-•---•--------------------- --------------------- -- ------------------------------------- --- ---------------- - ---------- ------ ------------ ----------------------------------- ------------------------------------------------------------------------------------ FINAL INSPECTION BY:... _. I ----- --- --- - ----- -- - -----------------------�`--� Date---- ----�---------�•----t-�__--------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 730 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 8-59 ZM 5.62 ATLAS