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FOR OFFICE USE: ------------------------------------------------------- / ----------------- ------ ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..l�rr�:�--•.•- ------------------------- ---- ------------------------- (Complete in Duplicate) Date Issued ___. Al, /� ._.-_..__::�._�:._._ 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 ascribed.. r This application is made in compliance with County Ordinance No. 549. cye l 1?0-0AI, ADDRESS CATIOX/ �--------- ---- - ---� .. � p- ...:- .i� Owner's Name - -- ------------------- Phone........................----....._f ' � �� a Address-.- j ------------------------------------•-------•-------------------------..._....--••-•----•-•. Contractor's Name------- -- -�J-- Phone-.................................. Installation will serve: Residence )Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of living units: ..I___ Number of bedrooms _7-_ Number of baths _f-- Lot size . ''--- ________________________; Water Supply: Public system ❑ 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 E!( Hardpan ❑ Previous Application Made: (If yes,date---------_ --------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ ._ TYPE OF INSTALLATION AND SPECIFICATIONS: ] Septic (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ank: Distance from nearest well_�iCl-�_--Distance from foundation___f__Q----..-__.Material........ ... . .. ......... .............. "! No. of compartments------ Size__ ? Liquid de th.... ......... ....._Ca aci %r4?q__ -. Disposa field: Distance from nearest-well �.-Distance from foundati9n...-Z V....•---•Distance to nearest lot line_'______._.... 1" Number of lines--------/-------------------------Length of each line--,.*?------,�-/-.-_-----Width of trench-.--4----Z.....------------.--- Type of filter material..�4�--- .Dep#h of filter materiaL.._..�l�-1....Total length.......... jq.------------------------- See .............:.�__..__ � 7_.,Z.,... i� k i Seep�Pit: Distance fo neer�st well---- =___Distance from f� ndation___��.._.___...Dis#ante to nearest lot line-_$.......... Number of pits---.I-/-------------Lining material--_____Size: Diameter._._.�3 N--___--Depth_-.oz _______..______.___ ❑ ( _ �r�istance from fou%ndiation--------------------Lining material__._____._..-__-_______________------ Cesspool: Size: D Diameter nearest well -- - FN_pth-------- ------------ ------- -- �--------------------------Liquid Capacity-------_--..--------------gals. Privy: Distance fromi nearest well-_________._�_________________________________Distance from nearest building__________._______-------.._________-__-_. ❑ Distance.�to prelst lot line------------- -------------- ---------- ------------ , .... O .t.A--- � FL Remodeling and/or repairing (des rile):_ . Z �� �+ r k _. _T ---1--------------------------------- --------- -•---- ------------------ ----------------------- ---------- -------------------------- . ; . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, Stafe-laws aand.,rules andiregulations of the San Joaquin Local Health District. v r r (Signed �• e`� n.. .. ----------------------- •------------------------- dor Contractor). r By---------- - -.. -----------------------------------------------------(Titlel---------- ............................... (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------•--••------ ------- DATE".'L./ " REVIEWEDBY----------------------------------------------------------------------------k (v------- ---- ----. � r BUILDINGPERMIT ISSUED-------------------------------------------------------------- ------------ DATE..------ -------------------------------------------------- Alterations and/or recommendations:-------------------------------_-------------- ------------------------------------------------------------------------------------ ----•---------------------------•----•----------------------------------------------------------------- ------------------------- FINAL INSPECTION BY:. ------------- Date.-/-�+ _ -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS