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_ .._ _ _. _ _ __._rte_-- - — •- - FaR OFFIC-E USE: + � � ------ - 4 -- PLICATION FOR SANITATION PERMPermit No. . ..-- + �S APIT � ------ --------- Comp / + - T_ - .3 - lets 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 County Ordinart a No. 549. ------------------------------------- JOB ADDRESS ANQO ATION -- ---------------- - -------------------------•-••--------•-------.._..----------•---- /r � Phone . Owner's Name------C.r? ------ Address......-----_------ �J / . --------------------- Contractor's Name.. •- --.-------- ---•-••--• Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: t --- Number of bedrooms _ -. Number..of baths __ ___ Lot size _____. -------•- Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table 41A ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel f-1SandyLoam E] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date------------------- ) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e0ic-dank: Distance from nearest well____-.--.______Distance from foundation-------------------_Material-------.----------------------------------------- ® *� No. of compartments-- Size----------------------------•---Liquid depth---------•------ ---------Capacity----•---_-----•------- Disposal Field: Distance from nearest well Distance from foundation._ Q.-----•---Qistance to nearest lot line__r _..._•__.. Number of lines------/--_- _------- _--Length of each line--------------j a-;�• Width of trench---.-07.s/..---•----�• Type of filter material._ +_� "ELrC}epth of filter material____ ----------Total length ...................... ---------- \ -� G+ � Seepage Pi+: Distance to nearest well '"'---Distant J{.om f ndation__.__yl�----..Distance to nearest lot line_________________ Number of pits-------/------------Lining materia!__ --��--Size. Diameter----- - - ,--- Depth __._._ t_--•---------• t Cesspool: Distance from nearest well_________________Distance from foundation..------------------Lining material------------------------------------- [3 _ --______-____..___---____..._..--_❑ 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 r 'fy that I have prepay d this apiplication apo that the work will be done in accordance with Sen Joaquin County ordinances, Sf to ws�and rules and r gulations�of the n oaquin Loca gHilfn�i strict. V �- (O ner and/or Contractor) (Signed) ------------ -••--------- ` ��'v v� ; Br--------------------------------------------------- ----------- ----------------------- ----------------- ----------- _A41 - ------------ (rtle} (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 B - ---- ----- ------- --- -- DATE__. -�---- QATE--- -- --------- REVIEWED BY------ - BUILDING PERMIT ISSUED--------------------�----- DATE.--•---•--------------------------------------------------- Ahterations and/or recommendations:___',__ Q d _._ - -- •--- •------------- - •-- ---•----------••------ •-----------• ---•--•----------•-----•-•--------------•---------------•---------- FINAL INSPECTION Date_- ------ ----- --- ----------•----- ! . SAN J QUIN LO L HEALTH DISTRI 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8.59 2M 5-62 ATLAS .aWa