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FOR OFFICE USE: ` _-----_ ------ ,,� ----------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------------------- (Complete in Duplicate) Date Issued _-_. ------------- This Permit Expires I Year From Date Issued _3....... Application is hereby made to the San Joaquin Local Health District for a permit to construct and instalFthe work herein described. This application is made in compliance with County Ordinance No_ 549. JOB ADDRESS AND LOCATION----- -2-<-9-----•.............. -=---------- -- =--- ---------- .......-.._.. Owner's Name--------- ---=- ---------- ------ `-- mo i`-- -------•--------•----- Phone. 'p e� Address---------------------------•-------s-r-----------.....-------------•-----•-•---------•------ ---""-------------- ---------------------•-------•----------------------------••----------•------- Contractor's Name....................... •ftp. /O__ . . Phone.......... Installation will serve: Residence [3 Apartment House ❑ Commercial ❑ CTrailer Court ❑ Motel ❑ Other ❑ Number of living units: ./_._. Number of bedrooms S-___ Number of baths ----1-- Lot size __--------------- _________________________ _______ Water Supply: Public system ❑ Community system ❑ Private 0' Depth To Watdr Table`s?-fit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loom ® Clay ❑ Adobe❑ Hardpan ❑ 0 Previous Application Made: {If yes,date---------!--------.-} No [}— New Construction: Yes ❑ No B-�-FHA/VA: Yes ❑ Nom—� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public'3ewer-is available within 200 feet.) — Septic Tank: ,� Distance from-nearest well_. ____.,i` Distance from foundation_._____7—_-�______-Mate0iaL_ -.•_________________ [T' No::of compartme'nnts . -~ "Size--- �' ._:_._Liquid`depth� -___tel_-Capacity_..-- `"-_�'__ Disposal`Field: `� Distance from nearest well-,L_m�- Distance from foundation__--�_�__� Distance to nearest lot line_____ --- Number of lines--------------- _________------Length of each line__ _��_L1rY°Width of trench.__.________________.___ Type of filter material...... Depth of filter material------%_"-_Total length------------l_6�. ................. Seepage Pit: Distance to nearest well=`-_ s __Cz.__Distance from foundation___--- Distance to nearest lot line____---- Number of pits---------------------Lin ing material -.Size: Diame#er4-, ._..._.Depth----------- -~............... Cesspool: Distance from nearest well___,':_---------Distance from foundation---_____------------Lining material-__.__._____-__-__--__--__-_-_--_-_-_ Size: Diameter----------------- ---------N'-.-Deth------------I----------------------------------:--L'i uid Capacity gals. Privy: Distance from nearest well-------- ----------------------- .______Distance from nee est building__________________________________________ ❑ Distance to nearest lot line--------- ---------------------------------------------------------------------'-------------------------------------......-•---------------- Remodeling and/or repairing (describe)___________________ __-----------1 A. -- 4i - I hereb certif hat I have prepared this application and that the`work will be done in accordance with San Joaquin County i ordinances, ate sanrule�and�reg�ula o s of the San Joaquin LcI al Health District. 7 ----------Cf''-c ----------- 't -----=----------------'--- ---------- Owner and/or Contractor (Signed) -- ( / ---------------------------------- By:................................. -------------------------------------------------------- "C. """."` ----------.----------(Title)-----------------------------------------------................. (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- =&-`1-- - DATE- ---- ---------------- REVIEWEDBY ----- -------------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED--------------------------I-------------------------------------------------------------------------- DATE.....----.......---•---•-•------------------- ---------- Alteration and/ recommendations:----------i------ -.:___ -------- ---------------------•--•---•---------------------------------------------- •-----------------...._.. l r!� r�e__1�r:.- ., C r---- Ql ------�" ,�A Q �S ' r'' l x 3i _ .� ---------------•------------------------•-••---------------------------------------------------•---•----------- ----------.---------------------------------------------------------------------- --------------- ....... FINAL INSPECTION BY: ------------------------- Date-- ----------- ------------ ----- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS