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FOR OFFICE USE: ---------------- --- -------------------------------- _____________ __ _ -._- APPLICATION FOR SANITATION PERMIT Permit No. .� �(..! --- -- ------- -------------------------------------- (Complete in Duplicate) s ........ - This Permit Expires ] Year From Date Issued Date issued116� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the O work herein described. This application is made in compliance with County Ordinance No. 549. l2£P JOB ADDRESS DLO ATION - �____ 4i-vt�...--- - ......... -- ---- F Owner's Name _ ---- Phone.................... ------------ a � a .. .«.. _-__ --__.•_ _ p _. Address.........1".3-3--------- ........---•-------- Contractor's Name------- ---- -•-td---------------•---•----..................-------------------- Phone----------------------------------- Installation will serve: Residence E] Apartment House E] Commercial [Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ________ Number baths -------- Lot size ..........................!�4..-..._.______________________.- Water Supply: Public system F] Community system [Iivate Preo Water Table ________ ft. Character of soil to a depth of 3 feet: Sand E] Gravel [-] SandySandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ ; Previous Application Made: (If yes,date---------_----------) No ❑ New Construction: Yes eNo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s7er is available within 200 feet.) SeDistance from nearest well__ _..Distance from foundat�n.__ ___.._Material____ .___________-_.__________ ---.__-___-----. No. of ��.artments_____ �? Li uid de .th_ ---_.-Ca acitY / - -- N .. .._.. r ` � � Dispos field: Distance from nearest well_.. ____bistance from founda�t�ign____��________Distance to nearest lot Gne_,�......... Number of lines________--------------______ ength of each line-(W:"_-7Z_----..Width of trench.__ 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--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation_--._.--------------Lining material--_._____.___________________________ ❑ Size: Diameter-------------------------------......Depth---------•-------._..._._._..-•---------------•----.Liquid Capacity-------_------------------- Privy: Distance from nearest well-_____----_---____---_____________._ ---.---Distance from nearest building__________________________________________ ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------••------:,-------------------------------------------------------------------------------•----------•--------•-----...................... ------•-----••---•-----•--------------•-------------------------------------------------------------------•---•-----....-•----------...------•----•----------------------------------•--------------------------------------- ----_1--------------------------------------------------------------- -------------------------------------....--•--•-----------•--------•------------•-------------------------------------------------------------•------•--•.-------------------------•-------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ws, and4ruled regul� of the San oaq 'n Local Health District, a(Signed)------ ...... - ------ f -------------••---- --------------------------•---------...(Owner and/or Contractor) Sy:.....- ---•• ---- - -------------------------------------------(Title)-------------------------------------------- - -- ---- ---- (Plot plan, showing size of lot, location f syste relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.- - ------------------- ---------------------------------------- DATE----,�.-_ 7'° _0---------------------------------- REVIEWEDBY---------------------------------------------------------- ------------------------------------------------------------------- DATE---.._-.---------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------- --- DATE----------- ---------- Alterations and/or recommendations------------------------------------------ ----- -------•-------------------------------------------••-•-----•--•-••--•-••-•-----•-----------------------•------ -•---......-•------•---------------------•----•-----------•-----------------------•-- ----------------------------------•-•--••--------•-•----•--.-------•--..---.-..----•----•-------------..------------------•----------•-- ` FINAL INSPECTION BY:---- -- �------ - --------- - -- ------------------------ Date------------------------3------ -----•---- -------------• --- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strout I Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS +