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Ea �� i --------1-:'�; APPLICATION FOR SANITATION PERMIT Permit No. ._/�... !-� -------------- �� ; --------- (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. -mss ..°_ ,,> _� 4-,, JOB ADDRESS ANLOCATION.-_.._ ._ •----- ••- ------ Owner's Name---------- ------------ Address------- Phone.... �I Address------ . ------------ Contractor's Name....... ' .---••-----•---•------•---...---••--••------•-•------•- ---------------------- Phone----.........__.._. Installation will serve: . Residence Apartment House ❑ Commercial ❑ Trailer Court E]; ❑ Other ❑ Number of living units: ___L_ Number of bedrooms Water Su S--- Number of baths __.1___ Lot size .... PPIY� Public system • �••--•-�C__COQ � y D' Community system ❑ Private ❑ Depth to Water Table ...`.... ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ ❑ FHA/VA: Yes ❑ No E] I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from❑ foundation-_.,of compartments-____..__--------------------- _____..Ma#arial__.___..-____.____..__.._._• --••••••..........-- -----Size------------- ----•------ Liquid dell ------------Capacity____ _____ _ \ Disposal Field: Distance from nearest well P v 7tE Distance from foundation__.__ Distance to nearest lot line.. 4- Number of lines.___- - ••• Length of each line--__-•_- ---Width of french-_. - �, Type of filter material._. .- __ Depth of filter materia------Total length----- Seepage Pit:r Distance to nearest well-_____.r_.�-___Distance from f undation....L a_........Distance to nearest lot line...... /- ember of pits.___...__.___.--_ Lining material___ -r , ...Size: Diameter_._ .` ••- ' --Depth------- 5�------------ Cesspoo: Distance from nearest well------------------Distance from foundation.._______._- -- ---..Lining material_..-----------•----------••------•--- ❑ Size: Diameter----------- --------------------------Depth----•--------------•--- -• Liquid Capacity ---------------------------gals. Privy: Distance from nearest well:`______________________..__---------- -----------Distance from nearest buildin ❑ Distance to nearest lot line----- -----••--- 9 Re odeling and/or repairing escribe : - � - -------------- - - .......... -• "fes.. __ ..� •- - -�-• �- dr -----•----- = I --- here y certify that I have prepared this application and that ---------the work will be done in accordance with San oequin Coun ordinance,s`,�tate laws, d rules and reguI fie of the San Joaquin Local Health District, (Signed)---1--____ _ W _ 3 ` -••-------- --------------------------------------- _______________________(Owner and/or Contractor) BY:---- ----••------------------ (Title-------------------------------------- (Plot plan, owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ti APPLICATION ACCEPTED BY------- ._-_______ --- -- - DATE------- ..---- EVIEWED BY----•----------•---- ----------- ----- -----_ DATE-------------------------- UILDING PERMIT ISSUED-_------------ ------------ ---------- -------------- ••------ DA Alta afio s and/or recgm ndations:- --------------------------------------- •-----•------------•- 3 -- - .. -- ------ ........................i!n,F � __________________________________________________ --------------------------------------- . _ ___ _________________________•-___.._-.-__..._-___-_ __ FINAL INSPECTION 1 BY:.--t� "-----_ -- -- Date..... -Y--- ................................ i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REV]BEo 8•69 IM 5-61 ATLAS