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FOR jt4 ._�{(,_z_f_�,�.-- .-- APPLICATION FOR SANITATION PERMIT Permit No. .-., 3.?. T ---------------------------------- --------------------- (Complete in Duplicatel ��G . ---------- This Permit Expires 1 Year From Date Issued Date Issued .........._t- -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 o. 549. JOB ADDRESS AND LO ATI •--- ^• r.,� /7012- 1 `-'�-' Owner's Name-------------`� . ---• ---••-•-- +-------- - ----- - -----•----."_----•---------------_-------------------------•----. Phone...............••••................. :. - -- -- --- -- Contractor's Name. �`' t .. r3---•------- Phone................................... Installation will serve: Residence partmen H use ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _..I_... Nu bar of bedrooms .,Z_ Number of baths ----I. Lot size ..n Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table __Z�0_fflft. Character of soil to a deptli.of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 'Clay ❑ ' Adobe 8"'Hardpan ❑ Previous Application Made: .(If yes,date--------------------) No Q New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S 'c Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- No. of compartments--=---------------------•-Size--------------------------,:_..Liquid depth--------------- ------Capacity................. 11 I'r D sal Field: 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_____________..________Total length______-_=-.--..---.----_________-__----- I i Seepage Pit: Distance to nearest well__I_l�__.i____Distance from foundation____ ._Q..___.Drs an-alto nearest lot line____ s^__._ aa Number'of pits____I----------_------Lining material---- C _-_-_Size: Diameter____- t _ - -__.Depth-------- -� ' :. --------••- Cesspool: Distance from nearest well_________________Distance from undation-_-_-_______.-----Lining material--------------.---------------------- ❑ Size: Diameter---------- -------------- ------------Depth---:------------------ ------------------------Liquid Capacity----------------------------gali; - Privy: Distance,from nearest well----------_--------------------------------------Distance from nearest building------------.............________________- ❑ Distance'to nearest lot line-------------------------------------------------------------------------------------- I Remodeling and/or repairing (describe:_____ _ ---;----- ------- - -. .- __ _. .... __ -. ---------------- •----- ------ ---- _-••-•------------ ------•-------------------------------------------------------------------------- ------------•------•-------•---"------------------------------------------------------------------------------ ------•--------------- I hereby certify tha l have prepared this application and that the work will be done in accordance with San Joaquin County, w ordinances, St las, a d'rules and regulations of the San Joaquin Local Health District. (Signed).:,,• • --- °Fc- T' " -� --------------------------------( " Contractor) {rile) BY: ------- - -•----- ----- - ----- -------------------------------- ----......" -------------- (Plot plan, showing size of lot, location of system in relafa to wells, buIngs, etc., can be placed on reverse side). - F' t FOR DEPARTMENT USE ONLY ... APPLICATION ACCEPTED BY-------- - -- ��' ---------------------••-------•---------- '-------- DATE...-- �� '13------------------ REVIEWEDBY--------------------------------------------- :---------------------------------------".----�: DATE. - BUILDING PERMITISSUED-------------------------------------- ----------------------- ------------------------1- DATE-------------------------• -- Alterations a d/or rata encrations______________ __ '�__._.- _ _____ .___ -____ ----- ----- -�- --------- ---- =�f - ma= r=x = ---------------------------------------------------------------- ----------- - I ----------."-------------------------------------- ----- FINAL INSPECTION BY: fSAN `'` ---------------- Date------- .. � ' " JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street est Oak Street 124 Sycamore Street 205 West 9th Street " Stockton,Callfornia Lodi,California Manteca,California Tracy,California E5 9 REVISE[] 8-59 zM 5-62 ATLAS