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FOR OFFICE USE: - -- -- --- ----- .......................____.____._._...-- ----- APPLICATION FOR SANITATION PERMIT Permit No. ..).�/..lY......9 --- ----------------------------------------------------- (Complete in Duplicate) ml --.-.--- This Permit Ex ires 1 Year From Date Issued Date Issued ....................... Application is hereby__ntad®j�o the San Joaquin Local Health District for a permit to construct and install the work here' described. This application is made in compliance with County Ordinance No_ 549. OB `ADDRESS ND LOCATIONA` 4--!- _f_- .- ------------ --- Owner's Name -------------- Phone----------------------- ...... --- --------- - - - -------------•------------------------------ Address (pa-- ;- = - Contractor's Name---- _ ----•---•- •---------------------------------- Phone................................... Installation will serve:;;"Residence [( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.'�_ Number of bedrooms __ __ Number f baths _1- Lot size ._ .....A -----__•_-______-. Water Supply. Publics stem ❑,. C6mmunity system ❑ PrivaDepth To.Water Table ________ ft. � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam �Ciay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------1 �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.) � . a"foundation Septi Tank: Distance from nearest well_-_�'d______Distance from"oundation_____�_QMaterial _ ,fir'-+-..+� ...________. I" � i!. No..of•compartments-: �_._^_____________Size___ '_.._,_. :.,__Liquid depth__..- - 2-.f._..._Capacity.j_v---0 ..... Disposa Field: Distance from nearest well...__-sO----Distance from foundation..---__.......Distance to nearest lot ne.....�r......_. 1. Number of lines-------------/__________pp___� #Length of each line______ ip- ___L_!7._`...-_.._.Width of trench._____ .............. ...._.__. ' Type of filter material-.._!1 -fi /-----Depth of filter.material_____'_ ...Total length...... ... ....:.................. Seep Pit: Distance to nearest well-----%__4___Q------Distance fromifo ndation__--_/..Q.'__-.Distance to nearest lot well_ - _ - line,-S- ePsLinin9material---- )iameter-_ � Depfih______�_ ------------------- Cesspool: _`_____ __________ Cess ool: Distance fromnea�est __ Distance-,from fotnda}pn -Linigmat �al.. ---------------------- ----------- 13 Size: Diameter_____________________ __De th--------------------- Liquid Capacity -. --gals. _ Privy: Distance from nearest well ________________________ D:istance from:nearest building - ❑ --------------Distance to nearest lot Eine____________________ ___ Y'--- -... a3 - ' . ....--•--- ----------------------------- repairing.(describe):------------------ _: �. ��—- 1 -- - -- -- ' '�•2- !- --_ - --- ...-------- ----------;------------------------------- --4•-- - - - - -----------------------------------------------•--•--•------•---------------- _-A!!!"'_-------------- I hereby certi y that I have prepared this application and that the work wili,'be-done in accordance with San Joaquin County ordinances, Sta ws, and rule nd regulations of the San Jo uin Local Health District. �-____ ' ' Owner and/or Contractor (Signed) = '= -----------------( V - By:---- ------- + -� ------------- ---- - - `` { tie)---------------------------------------- - - (Plot plan, showing size of lot, Io ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY q APPLICATION ACCEPTED BY-- ------------------------------ -- --•--- DATE....<--f11G-G REVIEWEDBY--------------------------------------..-........ --------- ----- -------------- ------------------------------ DATE-----•-----•-------•---•----------- BUILDINGPERMIT ISSUED.....------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations:--. -------- -- - i 4 S ! - k ---------_---- .__ --•---•---••-•------------------ ------------------------ s -_--.F-------------------------------------------------------------------------------"--"...-..-----------.---------------------------------------------------------------------------------.-------_-------------------------- FINAL INSPECTION BY.. .i r,r .--------------- Date--f. -------1-------------- Y SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street �0; 300 West Oak Street 124 Sycamore Street 205 West 9th Street' v } Stockton,CaliforniaAll '�I Lodi,Californian fn Manteca,,California 3 Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS a `�! �- '� J�•�,A,t s