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FOR OFFICE USE: r - j — �7 APPLICATION FOR SANITATION PERMIT Permit No. ---!•` -• ------- --- ------------------ ------------------ f (Complete in Duplicate) Date Issued _`1._-i..�`---- -------------- This Permit Ex ires 'I 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 County Ordinance No. 549. o:_I --- --------------•------••------------------------------*------------ JOB ADDRESS D L CATION___-•- ��j" --- ---------- - ( ,rte - Phone-..... Ca�S N4`r C •- Owner s Name---- __ _ --""""�----""--"""--- Address----------- --------------------•---------------------. -- -•-------•-----•----•------....-•-- Contractor's Name-----.....--•-__-• --------------------- ----------------------I------------- Phone—...........------------------ Installation -------"------ ---------- JZ Installation will serve: Residence ❑ Apartment House ❑ Commercial V Trailer Court ❑ Motel q Other Number of living units: ."� Number of bedrooms _--� Number of baths,-A._. Lot size ____. _S--__---- --- Water Supply: . Public system IX Community system ❑ Private ❑ Depth To Water Table ......-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay-�Z Adobe s e[j Hardpan rd an ❑ Previous Application Made: (If yes,dote-- -----------------? No [I New Construction: Yes E] No F1A/V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well --Distance from fo�dddatlo n__._.d- - Ma aria)-.---. - `"f``--- : Liquld de th CaPaafiy... No. of compartments____-_ - -------- Disposal Field: Distance from nearest well--------_ I�_ _.._Distance from foundation--. _v..--..Distance to nearest lot lin -Length of each line---------- .Width of trench--.__-... - Number of lines----....---_�---------- g 7---'---- 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 x Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material--------------------------------- els. ❑ Liquid Capacity-------------------""----•--9 Size: Diameter--------------------------------------Depth------------------------------------------------------- Privy: Distance from nearest well-------------------------- ---- -Distance from nearest building --- Distance to nearest lot line----------------------------- -- -{ -------------------------------------------------- ---------------- Remodeling -•-------------- ------------------------------ Remodeling and/or repairing (describe)--------------------- ---------------- -•------------------------------------------- ---------------------------------------------------------- --------- ------- 1 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 runes and regulations of the San Joaquin Local Health District. '"" ------ (Signed) -------------- -------------•-----------•---(Owner and/or Contractor) --------- -- - ------- By ....... ------------ - ----- -- -- --------------(Title)--------------- -------- .............-............. (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 I APPLICATION ACCEPTED BY -------------------------•------ ----------------------- DATE----Ir -'------ = b-"---- --•- REVIEWEDBY-----------•------------------------------------------------------------------------------------------------------------ DATE - BUILDINGPERMIT ISSUED--------------------------------------------- -------------------------------------- Alterations and/or recommendations-------------------------------------- ----------------•----•--------"------------"------ ------------•------- -------------•- ----- ------ ----------•--------"------------•--•-•-----•"----- -- - ------ 1 --- -----••----- ----------�------------------------------------------ FINAL INSPECTION BY .._.. - ....- _ . _ s --------- -17--------24--- ----- -- --- --------------- Date-"_---- SAN JO Q IN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED a-s9 2M 5-62 ATLAS