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FOR OFFjPEOSE: g - APPLICATION FOR SANITATION PERMIT Permit No. ..;�3�---.�----.7. . -------------------------------------------------- - (Complete in Duplicate) ,// ------------------------------------------------I-----.--- This Permit Expires 1 Year From Date Issued Date Issued .___7I �2 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 549, a JOB ADDRESS AN L Cts..... - - - ---------------- .-- --- Owner's Name........ It..... ..';_! t Phone ---------------•-------•-••••...•--- Address----------•----------------•-------;---- -/r------ Contractor's Name_-------------- ......................................... -- . �-•---•-•..................... Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units.-. Number of bedrooms _ Number of baths ___ . Lot size __.. f. ....".. a.Q___________________ Water Supply: Public systeriCommunity system ❑ Private ❑ Depth ro Water Table -------- ft. Character of soil.to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R' Hardpan ❑ Previous Application Made: (If yes,date. _-g- .- ___) No ❑ New Construction: Yes ❑ No @jr�FHA/VA: Yes ❑ No ❑ k 4i TYPE OF INSTALLATION AND SPECIFICATIONS: I kA (No septic tank or cesspool permitted if public sewer is available within 200 feet,) ti nka Distanceefrom nearest well-----------------Distance from foundation....................Material....__...__.___-_______.____------------___-••--. No. of compartments--------------------------Size--------------------------------Liquid depth..........................Capacity--------•-------....... I i a F d: 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._ :____ k_-Depth of filter material-----------------------Total. length------._.____________-..._-_----------- � t i cy e P Distance:+o nearest wet � ��....Dista c m f undati /,� on .-•---•---. 'stance to nearest lot line-' �r Number bf pits_____/_____________Lining materia _.Size: Diameter__ - ............Depth__.®?_?_..___________._ ' d .._ Cesspool: Distance'from nearest well-----------------Distance from foundation---------------------Lining material------------------------------------- El Size: Diameter--------f-------------------- --------Depth----------------------------------------------------Liquid Capacity---------•-----_-.........gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-------------------------------------- 0❑ Distance'to nearest lot line------------------------------------------------------------------------------------------------------------------------ .............. !iY } Remodelingand/or repairing [describe):-------------------------------------------------------------------------------------------------------•------------•----------'----------------------•-- --------------------------------------•--------------------- -•----------------. --.--------------------•----- .---•--•---•---------------•-------•--•------------•------------------•--•-------------------------- II ' -------------------------------------------------�-........--------•-•----------------------------------------------------•-- --------•------------------------------------------------------------ •-- --- i ------------------- -----------------------=--------- .--- ----------------- ----------------------------------------------------------------------•-----•-• ----------------------------------------------- I hereb ce ify that I have rep red this application a d that the work will be done in accordance with San Joaquin County ordinances,Ftes, d I regyation of the Sa aaquin Local Health District. Si ned l�G�[. ( and/or Contractor) ( g ) i er S •--------------------------- ---------- -------- - t--e) Y• -----•--------- {Plot plan, showing sire of lot, Iota system to relation to s, w gs, etc., can be placed an reverse side). FOR DEPAR NT USE ONLY APPLICATION ACCEPTED"BY-- ---� -----------------•---------------------------------- - DATE----- -------------------------- REVIEWEDBY----------------------"-------------------------- ---------------------------------------------------•----------•-......... DATE---------------------------------------- -•-----•-------- BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------:----------------- DATE--------------------------------------------------------- Alterations and/or recommend'ations:.--------------------------------------------------------•----------------------------------•-•-•-----...------•---•---.-----•---------_--__._----•---------- --------------------------•--•---------------------------------- ------- ----------------------------- --------------------------------..----------------------------------------------------•---•---•----- •---------- ---------------•-_-•-----.-------•------------•------------•--•----•--•--- ------------•---------------•-----------------------------------------------------------------------------•----- ----------------•------••-------- - - FINALINSPECTION BY::-ri----L-----1 ------------------------------ Date----------y------------------------------------------------------------ SAN ---±- -----P=J--------------------------------- ._.SAN JOAQUIN LOCAL HEALTH DISTRICT e 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California £S 9 +REVISED 9-59 2M 5-62 ATLAS