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FOROFFICE USE: e r _--_ ----- APPLICATION FOR SANITATION PERMIT Permit No. . � -------------------------------------------------------- (Complete 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 Ordinance No. 549. JOB ADDRESS AND LOCATION__..AP/'_7--------- �_.._./ ------------------------------ 5`TKiV Owner's Name �1,......L�..--------.1'f��j�. ��F .---------------- ----------------- --------------------------------------- Phoned O-10or^ ---•--- Address - fit . `.�f �4!r................ Contractor's Name-•---- C�r -•. ' , ! fr� .��Y✓S' ,e .............. Installation will serve: Residence [jKApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_, _. Number of bedrooms _5-- Number of baths _/... Lot size -------ACeK.....,fv-�.�.................... Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table 41.;, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe EJ' Hardpan ❑ NkN Previous Application Made: (If yes,date____________________) No Q ' New Construction: Yes ❑ No J!r FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material______________.________-_------.-_----.--___---_. ❑ No. of compartments--------------------------Size-------------------------------Liquid depth---------------- ---------Capacity...... Disposal Fielcil Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line___-___..___.-. - ❑ Number of lines-----------------------------------Length of each line--.----- .----------_-----Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material----------------------- length................................ ...__._:__ Seepage Pit Distance to nearest well— Distance imm foundation___ _____.Distance to nearest lot line....3.......... Number of pits_____------------Lining material.____ _S' ...Size: Diameter-----r.7!3-- _____Depth________________________ Cesspool: Distance from nearest well----------------_Distance from foundation--------------------Lining material------------------------------------- ElSize: Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well_________________________________________ ______Distance from nearest building_________..___________________.__..___.._. ❑ Distance to nearest lot line---------------------- ----------------------------------•-------------......... -••----•---------------------------------------------------- Remodeling and/or repairing (describe):..... s �D T ._._ . .. t. 7-----•----------•--•-------------------•------------- ------------------------------------------------------•----------•------------------------------•-------------------------------- •------------- ••-----------•-------------------------------------- -----------------••---------------------------•--------•-------•--••-----------------•----------------•-••-----------------------------•----------------------------------------------------------------------------------- ----------------------------•- ---------------•-----••---------------------------------------------•---.--------.---------..------------------------------•-----------------------•---------•--------•--- -------I--- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed).-------- - `--------------------____-----(Owner and/or Contractor) -011 1 By:. -,�-- --- ----------------------------- -------------------(Title)-------- .................. ................. (Plot plan, showing size of lot, location o sysif fem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - ---- ----- �`' --------------------------------------- DATE-- G-v REVIEWEDBY------------------------------`-• ------------ ---------- --------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED............................----------------------------I--•----------------------------------------• DATE------------------------------------•------------------------ Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- -------------------------------------------------------------•-- ---.- ---------------------------------------------------------------------------------------------------------------------------..........----------•--- -------I-V. II/-62---This--Pi,t---w"-•riot---inspec-tech-----c-a1-led---int--te---I-a•te-;---R-:1.0rurzh-;- - San------------------------------- -� + -� J- .-...+„rte=.G — �j C.....� .-u•- �`}r ------------------------------------ FINAL - ---------------------FINAL INSPECTION BY:.- ----&�7t� ----------------------. Date---- -- - �� ---------------------•------- SAN J UIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Weil 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 ZM 5-62 ATLAS