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FOR OFFICE E: APPLICATION FOR SANITATION PERMIT Permit No. ./�'` 1 � ----------- ------------------ -- ------------ ------- (Complete in Duplicate) - / ------------- ----- I This Permit Expires 1 Yf:ar From Date Issued Date Issued ..01 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, JOB ADDRESS AND C PION_.___. .__. -- ____ -}------- -----------------------.... - Owner's Name ---... •. ---------- Phone. -------•-------------------- - - - ............ Address Address Contractor's Name----- -------------- --------------------------------------------- Phon . 3�gop/ Installation will serve: Residence Apartment House F] Commercial ;Trailer Court ❑ ❑ Motel ❑ Other ❑ Number of living units: _ _.__.'Number of bedrooms -�- Number of baths _�__ Lot size _� ��_- ,�ff-------- ------------ --- ------- ------ Water Supply: Public system ❑ Community system ❑ PrivateX Depth To Water,Table yo ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {If yes,date_r 4-4-.�_._) No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Distance from nearest well_________________Distance from foundation--------------------Material .-_.___._._____._- No. of compartments---------- ------Size.------•----------------•-------Liquid depth--------------------------Capacity...-----•-------------- ' � I a d: Distance from nearest well_________________Distance from foundation-----------------...Distance to nearest lot line................. I Number of lines---•-------•-----------------------Length of each line------------------_----------Width of trench. Type of filter material----------------------.-_Depth of filter material__-._______•________..Total length______---_______---__ �1} � -----•-•---------- I Distance to nearest well_ 490 --------Distancom f ndation- line-..W t _.___..rQ�lStan�e to nearest lot ___..... Number of pits-------�____._______Lining material_/ _-Size: Diameter---.33 ---_.Depth_.__ R67 Cesspool: Distance from nearest well_________________Distance from foundation .-__------------.Lining material---------------------- ❑ Size: Diameter--------------------------------------Depth------------- ' --------------------._Liquid Capacity ' -----gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------- -_- ❑ Distance-to nearest lot line---------------- --------'----------'-- ---'----------------....------e---------•-----••---------- Remodeling and/or repairing (describe)______________________ ---- -----••------------------ --•--•....----•----•-•----------------•---------•---------------•--- - ---------•-------• -------- •---•-- -•------•------------------------------------------------------------•--------- •----------------•-•---------------------------------------•---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S 'Ke)laws, an4 rules4,7_. tions of the San Joaquin Local Health District. w ,J (Signed)----- • -- - tT - - ---------- ------- % � --- Owner and/or Contractor) By:- r�'�-� "��------ --- Title •-------•-------------------•--- (Plot plan, showing size of lot, location of system in relation o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--- ----- -. . DATE----- - /_.-- REVIEWEDBY--------------------------------------------------- -------------------------------------------------•------------------------ DATE------------------..._-•---••--------------------------'--•-- BUILDING PERMIT ISSUED--------------------------- - ------ DATE----- Alterationsa d/or recommendations:______ ✓ -- r__ .z,1 ::�__(� p c t „�� • .------ FINAL INSPECTION BY:GY-- - " Date------ -e- _ I............ --------------- --- --------- .•. SAN JOAQUIN 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 E5 9 REVISED 5-59 2M 5-62 ATLAS - . — N .