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FOR O,F�FIC USE: ' �r ....._----- c� .�.�-._�. �D APPLICATION FOR SANITATION Permit No. ..l_..`�.:.� --------------- ----------------------------------------- (Complete in Duplicate) �,... This Permit Expires 'I Year From Date Issued Date Issued t.��p.� 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 L CATION ,3-, -- -- --- -- Owner's Name e ------------------•--------------------- --•------------------•- ------ Phone-----••-----•-=-------------------- Address...----- ---------Address.....---- --'2 -- � --------------------------------------------------------- - --- - •- Contractors Name-____-- �" Z� --.----.. Phone..............•--_- . _-----••------------ ------------------------------•-•------------------•--...-------..._.....--••--•----•-------------- ...----..:-••--- Installation will serve: Residence�[nr"Apa4inent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 1 Number of living units: ---1�___ Number of bedrooms __;L_,Number of baths J.... Lot size --------------------- .------_ - --------••-- ommunity system C3 Private ❑ Depth ro Water Table Water Supply: Public system 2--c- .. Jft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [-] Sandy Loam L] Clay Loam ❑ Clay El Adobe�ardpan ❑ I r. Previous Application Made: (If yes,date----------------____) No Z�r New Construction: Yes ff"No ❑ FHA/VA: Yes ❑ No B' i 4 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._/12_f---------Material__ �`.�-"�--.---•.---- No. of compartments-._�-----_----------Size...3?--__.___,---Liquid depth_.._I-----------------Capacity---keegr4 (/U Disposal Field: Distance from nearest well---- ----------Distance from foundation,1.0_/--------Distance to nearest lot line__._ ...... Number of lines_�__J--------------------------,{,� ___Length of each line___ ----_..._____._•.Width of trench.-*.*----------_-___---•-_ �J Type of filter material--'Ta l— ----._-Depth of filter material---Jr----- ___.______.Distance to nearest lot line___g..._...... Number of pits__'----I------------Lining material_`_ -aC/�C.----Size: Diameter-- Dept h____... __...... i .--------- Cesspool: Distance from nearest well_________________Distance from foundation------------------.1ining material--------------------------- ❑ Size: Diameter---- -------------------------------Depth----•-----------------------:-----------------------Liquid Capacity------------------- ...gals, °" Privy: Distance from nearest well---------_---------------------------------------Distanc6 from nearest building_____..____--- ❑ Distance to nearest lot line----- -------•----------- Remodeling and/or repairing (describe):____ _ __.____fit`-_--- --�-------_-__ F -----------••-------------------------•-----•-----------------------------------------------------------•----•--•------------------------------------------••--------------------------••------------------------------------ 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 regal t ns f tWS Joaquin Local Health District. (Signed)------------------------•------•--------- ` -"---------._ -------------------------------------------- --{Owner and/or Contractor) By: ------------------------------------------------- -----(Title)---------------------------------------._....------__--------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY �} - --•----------- DATE_.-4_---A-..'. APPLICATION ACCEPTED BY----- ' P REVIEWED BY --- ' i ------- D ----------- ; BUILDING PERMIT ISSUED------------- ------------------------•------------------.._..---------------- DATE.. ... 1 Alterat' ns and/or recorm ncr tions: � -`--- - ------------------------------------------ . fes. - ---------------------------- •--•-------- - - r —I------------------------------- ----------------- -----------------------------------------.--------------------------------------------------------------------- - -------------------------------------------- --------------------------.------------•-------------------------------------------------------•----. -------------. - ---------------- FINAL INSPECTION BY:---- r---- -- ------ Date.... ._:-5. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 3-59 2M 5-62 ATLAS !