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FOR OFFICE USE: " - .......................... --------- ---------- -- - Permit No. . --- ----------------- -FOR - ------------------------------------------------------ APPLICATION -'FOR SANITATION PERMIT r� ------------------ (Complete in Duplicate) Date Issued --.--_------------------ t 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 descr ec). This application is made in compliancewith County Ordinance No. 549. �t JOB ADDRESS AND LOCATION�. ._ _ ..- ---� _ Owner's Name-- 4 Phone ,� , v ..__._ `... Address. �/ `.:--._.a�-••-- ' ------------ Contractor's Name - � ••----••---••------•------_..... Phone............................•--•--- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - - - Number of living units: _:�.-__ Number of bedrooms .2e-. Number of baths .1__.__ Lot size ___ ---------------•---•--•-----•----- Water Supply: Public system ❑ Commuriity system ❑ Private ® Depth To Water Table Ij r_ ft. Character of.soil to a depth of 3 feet: Sand E] Gravel [ISandy loam ❑ Clay Loam E] Clay E] Adobe 12 Hardpan Previous Application Made: (If yes date_..___-_-_.___.-__i No New Construction: Yes ] No [:] FHA/VA: Yes ❑ No ED TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well___4-_d Distance fr m foundation_-�q'--------M erial - Size--••-�---- :C---Liquid depth---- -----------------Capacity.-----1 "7... .. No. of comparfiments_._�----------------- � �--------- •-- � Disposal Field: Distance from nearest well--S� ........Distance from foundation.__l.___--____-..Distance to nearest lot line..._..-_-.... o Number of lines--;•�---{-------------------------Length of each line----i!---_------.------.Width of trench.--.'--,/-* th of filter material-./-?--------------Total length__/- ---•-----•-------- Type of filter maferial,�r_'�.--Ip y ,l � Seepage Pit: Distance to nearest well----/_--_____-_Distance from oundation.._ .�'.._._--LDistance to nearest lot line-4'___._____... _Lining material,/ � 7 Number of pits / --.Size: Diameter------F--------------:Depth__ - - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____.__-.____------•---- ----els. ElDiameter----- --------------------------- ---Depth----------------------------------------------------Liquid Capacity---------------------------9 Privy: Distance from nearest well___-.--.____._;---------------rte--- -------Distance from nearest building------------------------------------ �,. ❑ ---------------------- Distance to nearest lot line Remodeling and/or repairing (describe):------------------------------------------------------------------------------ -------------------------•----••-----•---_------.---- b --------------- ----••-------•--- E --- ---------------------------------- ---------------- ------------------------------------------------------- x 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ` ordinances, St.9t9 laws, and rules and regulations of the San Joaquin Local Health District. (Signed):!--. '�` G �•� --------------------------------- (Owner and/or Contractor) � y Title /By------------------------------------------------------ ---------•------------------------------ --------- (Plot plan, showing sire of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SY --------------------------•----------------------- -,P----------- --------------...------------- REVIEWEDBY--------•--------------------------------------------------------------------------- ---------------•------------------------ DATE---•------------._.-....--------------------------••-------- DATE--------•---------------------------------------------------- BUILDINGPERMIT ISSUED..--ata - -------- ------ --- -----------------------`--------------------------•------------------------•-------------•-------- Alterations and/or recommend'ations:___________________________ •• -------•-----------• -' ------------- ------•-•----------._.... .. -------•----------------••---------------------- -- ----------------------------------------------------- ------------------------_------------ ---------------------- - Date._ ---- ---......................... ---------- FINAL INSPECTION BY:�r!� �. 'S`-`'"--------------------- N SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amerlcan Street 300 West Oak Street 124 Sycamore Street 205 Wait 9th Street Stockton,California Lodi,California Manteca,california Tracy,California .ES 9 REVISED 8-59 2M 5-62 ATLAS