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FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT Permit No. _.—_------------- {Complete in Duplicate) Date Issued ..- _-----------_.................... This Permit Expires 1 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 Counttyy,O,rdinan e No. 549. ------------------------------------- JOB ADDRESS AND LOCATION._.__IJp3----_ , .--- Owner's Name ._ --------- Phone------------------------------------ ---- ---------- -- Address_._.•......--- ---� � ------•-----------•-•--------------- --------------------------------- --•-•------------------------------...... Contractor's Name--------- r� Phone..--------------------------------- Installation will serve: Residence ['Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units ____ Number of bedrooms _b--- Number of baths -3--_ Lot size ___—XP XAP8C> ---------- Water Supply: Public system n—cro—mmunity system ❑ Private ❑ Depth To Water Table -V_Lyft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er ardpan ❑ Previous Application Made: (if yes,date--------------------) No Ml-"'New Construction: Yeso ❑ FHA/VA: Yes ❑ No r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep Tank: Distance from nearest well_________________Distance from foundation__.______-.____..._.Material----------------------------------------------- .. �� No. of compartments--------------------------Size-----------------------------..Liquid depth--------------------------Capacity-------------- ....... X111 Disposal Field-, Distance from nearest well.l,� ------Disfance from foundation.Ai?------------Distance to nearest lot line_ ............. jF Number of lines--------- -•--•------- ------Length of each line------ - -- - -------Width of trench----- Uf ------------- r.,lpf Type of filter materiaL'J?QG4"----------Depth of filter material_.-_le7_ _-------Total length________________________________r__-__-_ r Seepage it: Dis#ante to nearest well_.~~--_______Distant foundation__/q...-_----__--Distancej to nearest lot line`_______________ 2 Number of pits---I----------------Lining material-._-4-7 ------------Diameter____.,-�-�-_-.Depth______.•-.-.2:[_rf ----•- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- els. ❑ Size: Diameter--------•-----------------------------Depth--------------------- ------------------------------Liquid Capacity------••--------------•----9 Privy: Distance from nearest well----------------------------------------- -------D•istance from nearest building-------------------------------.---------- ❑ Distance to nearest lot line------------------------------ -- ----------------•--•--------------•--------------- Remodeling and/or repairing (describe):------------------- ------------•--------------------------•-------- ---- --------------•-- ----•------- -•--------•-------•-----------------•-----•-----------•-•-------------•------ I hereby certify that I have pre is ap cation and at the work will be done in accordance with San Joaquin County ordinances, State laws, and r nd r ulati f the San aquin Local Health District. (Signed) (Owner and/or Contractor) -- ------------ ---- ------------------------ ---------------------------•----- ---------------------•-- Ttle (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- ____.-___ DATE__________ ___-- REVIEWEDBY-- ----------------------------------------------- DATE--------- •-------------_------- BUILDING PERMIT ISSUED.------------------------------------------------------------- DATE.. Alterations and/or recommendations:---------------------------- - ...-------------..---------------------------------------------------------------- ------------- 1 ---�- ------------------ FINAL INSPECTION BY:.----�-� ---�- ----------�'.---:------�- -------- -- Date-•------- ----7/_ 11____;7 -a- 1 - �---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strut 124 Sycamore Strut 205 West 9th Strut Stocktonr California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS