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FOROF IC USE: �nO3 ..... ......... 3---� ;�'' APPLICATION FOR SANITATION PERMIT Permit No. ../.._'�,�..--�.o --- ----------------------------------------------- (Complete in Duplicate) ' ------ This Permit Expires 1 Year From Date Issued Date Issued ---__. �__ �/! --. _. f�3 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 CountyOrdinanc o. 549. �J�} E JOB ADDRESS AND LO ATION.........06------ , Owner's Name __... Phone.................................... Address----------------•------ I Contractor's Name... 5 .. - - •- ---- -f-----------------------------------------•---............ Phone - � 44 7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _..... Number of bedrooms t_ Number of baths -/- Lot size ... : ................. Water Supply: Public system ❑ Community system ❑ Private Od'Depth To Water Tables,49ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ OF INSTALLATION AND SPECIFICATIONS: OTYPE n [No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well-----------------Distance from foundation---_----------------Material______..___--.-----____._-.._-_-_--____-- -----. No. of compartments_______-_-- - -------.�__Size-------------------------------Liquid deP.�h----..-.. ---------------capacity----•--------�..�... Disposal Field: Distance from nearest well-- Distance from foundation...../•------•____Distance to nearest lot line..... of lines___------ ___.__.--_ -__Length of each line---- f------ Width of trench------ �}�� Type of filter material. f_ G / __Depth of filter material___. _r _____.._.Total length______------------_-------�---..__._ Seepage Pit: Distance to nearest well_/DD__.------Distance fr m fo ndation__.�.Q:-......Distance to nearest lot line___ - Number of pits------./------------Lining material-' -Size: Diameter---- _, --��-----Depth___________- - Cesspool: Distance from nearest well------------ from foundation.__._._._-____--___.Lining material_-.__________________....__.______-_ ❑ Size: Diameter--------------------------------------Depth--.----•---------------------------------- ------._Liquid Capacity----------------------------gals. Privy: Distance from nearest well__________________________._______.----- ------Distance from nearest building________------___________----___-________. ❑ Distance to nearest lot line Remodeling and/or repairing (describe):------------------------------------------------------------------------------------•------•---•------------------ ------------------ - 1 1 -------------•-------------------------------•---- --------------------------------------------------------------------------------------------------------------------• - ---------•-------•----------------- -- -. hereby ify that I have p ared this application that the work will be done in accordance with San Joaquin County ordinances, S t 1 w5. annd rr. aregulation of the S Joaqui Local Health District. (Signed) ✓`� - -- ------ - --- -_ a --------------------------- wrier and/or Contractor) ---------- - J42- By:.- ~�� {Title) --- . -- -- ------- - ----------- -------- -- (Plot plan, showing size of lot, location of system to relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____-�'--------- DATE___-+"~---- _. REVIEWED BY------------------------------- ----- ) DATE BUILDING PERMIT ISSUED 4---_----------- ,e--------------------------------_v _ DATE------------------------------------------------ Alterafions and/or recommendations:__._______x,� -___________________ ____ --t••_-___ Cl ---.._...- / ` ... .. _. '`z r -------------- ------•- -------- •--- `x- ---------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ' ----------------------------------------------------------------•- ---- - FINAL INSPECTION BY:....`L -- . ----- O'- ----------- Date----•-�- �---�------- AIN ` 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 ES 9 REVISED 8-59 2M 9-62 ATLAS