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FO ,OFFICE U E: ' --------------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------- --------------------- (Complete in Duplicate) ------- ------------------ -- ---- ---------- This Permit Ex fres 1 Ycar 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. 5 9. JOB ADDRESS ND" CATION:_.______ - Owner's Nam ______ ____________________________ _______ _-- ---' _••- � _ I r✓ . hon - --- --•�-- -- d l� Address --=- -----•----------------------------------- -- • -- - - -•- -. Contractor's Name__________ ________•__ -._- 7 • - ------------------------- •--- Phone- Installation will serve: Residence 1W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motei ❑ Other ❑ Number of living units: .) Number of bedrooms__ Number of baths __/. Lot size .In_Q--� ..- ,5.:_!.•.-•--- Water Supply: Public systemCommunity system ❑ private ❑ Depth To Water Table.5-P ft. Character of soil to a deptg3feet: Sand ❑ Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-------------_____.) No New Construction: Yes ❑ No 2- FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Ic n : , Distance from nearest well_________________Distance from foundation--------------------Material_______.__-___._.____.____ ------------ ----•--- No. of compartments ------•---------Size------------•-------------------Liquid depth ----Ca Capacity tY.........--------------- s I i � Distance from nearest welt________________Distance from foundation___...______-____...Distance to nearest lot line.......... Number of lines------••---------------------------Length of-each line---•_-------_•----------_--.Width of trench-------••-:---...-_---- Type of-filter material._. ------•- ----- • WD epth of filter material----•---------------•--Total length---••----••-------••----•-----•----------- �Seepage Pit: Distance to nearest well istan e. r m f ndetion___��._----_.Distangp to nearest lot line_-- "1 Number of pits-______/ -----------Lining material_ Size: Diameter ---------•Depth--- --.••- `� Cesspool: Distance from nearest well________________ Distance from foundation..------------------Lining material___ .--------------------------------- } ❑ Size: Diameter---------------------------- ---------Depth----•---- ------------------------------------------Liquid Capacity--_-----------------•--------gals. Privy: Distance from nearest well-----------------------------------------_-------Distance from nearest building ❑ Distance to nearest lot line_____________________'___.___._____-_.- Remodeling and/or repairing (describe)--------------------------------------------------- ---------------- -------•-------------- -------------------------------- ------------•--------••--------------------------•---------•------ I hereby t that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t ws, ands s and regulations of the San Joaquin Local Health District. (Signed)_:-- _ _- __---- n rand/or Contractor) ------------ - -- ---------------------------------------- r .. ----- {Title} --- - --- ------- ----- ---------------------- --- -- ------- -- - - - ot plan, showing size of lat, location of system in relatio o wells, buildings, etc., can be placed on reverse side). } FOR D ARTMENT USE ONLY.. APPLICATION ACCEPTED BY- ----------------------------------------- DATE----- �---- _________________________ ________________ IEWED BY-----------•-------------------------- ------•------------------------------- --------------------------------•----------- DATE __----.--•--- - -----------••--------- UILDING PERMIT ISSUED•-----•---------------- N---•--------------------------------•-------------------------;-- DATE-------•-- AFterations and/or recommendations:______._. ._ --[' / ---------- � �- '�....--'- / --------------------------- FINAL - ---.FINAL INSPECTION BY:.___! c_ -_------ Z�`G -•--------- Date-- -------- - -- -- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak Street 174 Sycamore Street 205 Wes!9!h Street Stockton,California Lodi,California Manteca,California Tracy, 't-9th ES 9 REVISED 8-59 2M 5-62 ATLAS