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O OFFICE USE- ------ -------------- SE: 3 ----------- - -- ---------------------- -- / -------------------------_.-...__._ _.. APPLICATION FOR SANITATION PERMIT Permit No. .. 5__.�2.. ------------"--------------------------------- (Complete in Duplicate) Date Issued ... ._.s ---------------------------------- ------------- --- I This Permit Expires l 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 described. This application is made in compliance with County Ordinance No. 549. �� 14 �y ra JOB ADDRESS AND LOCATION l,&_ C!-------=•----- -" ----- s- 1--- r Owner's Name.`. _.:__ = ----------------------- Phone. Address........111. _.___------w- G� Contractor's Name.. ... - - -------•-•----••--------------------------------------------------- Phone----........................ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-I---- Number of bedrooms -_;'FL... Number of baths 2------ Lot size .__6�yr�, ,X__. _3__�_______________________ Water Supply: Public system -GD—Community system ❑ 'Private ❑ Depth To Water Table .krft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_------- __-----_l No ®-'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 , Septic T nk: Distance from nearest --------wg,(I _.____-Distance from foundation__��r-__......Mateiial__--'.`.................. No. of compartments_______--_.________________Size __ _ _��._5'Liquid depth__-- - pQ '1 ' . ---- Disposal Field: Distance from nearest well_777--_-_.__Distance from foundation--.-O........____Distance to nearest lot line_______!__ v p� -- - ---- Lang, of each line----7 ---------------.Width of trench----�-�!_'`--.------ Number of'lines-- of filter material _/ "____.-_Depth of filter material...- -----------Total length_.. Seepage Pit: Distance fo nearest well __-----------Distance from foundation_i DistancS to nearest lot line. [ Number of pits.__..d�A. ___Lining mater�al�QG_ __:__Size: Diameter----.-c - Depth__-- Cesspool: Distance from nearest well-________________Distance from foundation-------------------.Lining material................................. ❑ Size: Diameter--" Depth - ------------------------------------Liquid Capacity---------------------------gals, Privy: Distance from nearest eIL--'.-----------------a__ _------•------------Distance from nearest building-----------------------................... ❑ Distance to nearest lot line-,.-- -----------------------------------------------------------------------•-------------------------------------------•-- r Remodeling and/or repairing (describe):------ ------------------------------------------------..................-------------------------------------•-----•-----------........................ c ---------------------•--•-•----• ---------•---------•-•------------------•----------- --------------•--------------------•--•----------..._..---•--------------------------..................-_-----------------••------- 0 ------------------------------------------------ ............------------------------------------------------»------------------------------------------------------•-•--------••-------------•--------------------------- I hereby certify that I have prepared this applicatio and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations fh San Jo quin Local Health District. (Signed)..--•--------------------------•------------ ---•-- ------------ - ---- --- --- - -----"---------------------------------------------------(Owner and/or Contractor) By:. ------ ----- - - ------------- ------------=----drtis)----------------------------------------------- --------------- (Plat plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- . � --------------------------------------------- DATE..... -• � -- REVIEWED BY DATE BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE. Alter tions and/or recommendations------------ --------------------------- ' --------------•--- 4 ------------------ -----q ---------------------------------------- - ------------------------------ ---------------------------- ------- ----------------------------•-- ----------------------------------------- -----......-•------------- il "�� -----------� FINAL INSPECTION BY:.---. .-. . ••-- � bate.- • - ..3'=--- =-�-�- -------------------------------�--�----•---- � SAN JOAQUIN LOCAL HEALTH DISTRICT Ve 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Stroll Stockton,California Lodi,California Manteca,California Tracy,California E 9 REVISED S-59 2M 5-52 ATLAS