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� rvlcvrrlC.k U5 r _ APPLICATION FOR SANITATION PERMIT Permit No. -------------------- ------------------------------- (Complete in Duplicate) ------------"------ --------------- - ----- This Permit Ex ,ire, 1 Year From Date Issued Date Issued F 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. `P lay? , 'ffr� 7 �.✓ n - 46z�-�� JOB ADDRESS AND LOCATION,__�S` _a Owner's Name-_-{T- q� - - ----------------•------------•-•------------- Phone......................... Address........ - •------------•----------------------- 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 /l_, Lot size ------/ Water Supply: Public system ❑ Community system ❑ Private ®-TSepth to Water Table .__- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam Clay 0 Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----------_--------) No ( New Construction: Yes 2`140 ❑ FHA/VA: Yes E] No ® — TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S. ptic T nk: Distance from nearest well IJ IJ-V ' from foundation1 ----------.Material--- No. of compartments-----9------- Size �� Jdx � quid depth-_._. _ ` .___-_•-- _-- ................. --------- ac Disposal Field: Distance from nearest well.0'T_-______Distance from foundation__!�e___.__ Distance to nearest lot line...'.......... ❑ Number of fines.--•----•:2--------------------Length of each line------7tS`-__-_---------Width of trench_-------a•�✓--"----•-,-""- �S Type of filter material__. ------Depth of filter material____/_ref--_-_____Total length________l`r°_Y._ r ---------•------ Seepage Pit: Distance to nearest ellI?q--------------Distanc m f ndation.__14 ' .-...._.__.Distance to nearest lot iine_.___5�._..._ ❑� Number of pits_ __________ _____Lining material______:" �� ' -----Size: Diameter ---------Dept h------• �- Cesspool: Distance from nearest weil-----------------Distance from foundation--------------------Lining13 __- -•---••---...-- Size: Diameter--------------------------------------Depth------•---•----------------------------------------Li uid Ca aci q P tY --•-••---------_--------gals. Privy: Distance from nearest well____ Distance from.nearest buildin building-------------------------- --------------- Distance to nearest lot --- ---------------•----------•-----•-------•--- Remodeling and/or repairing describe)__________________________________ -------------•----------------------------------------------- ------- ----------••--•--------------•----------•-------------•- •--•---- I hereby certify that I have prepared his a lication and that the work will be done in accordance with'San Joaquin County ordinances, State laws, and rules and re atio of A San Joaquin Local Health District. iWl'Q ' (Signed)................------ 7 --•--•-- --- -- ---•-••---------------------------------•------------•--------------------------------------•---------{Owner and/or Contractor] By: - -w.-----------•--------- •------ --- I - -- -----�---------------•-----------•----------{Title]-------••------------------------ - --- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ REVIEWED BY ---------- ------------------------------------------ --- -- DATE-------------- BUILDING -------------•----------• UILDlNG PERMIT ISSLIED-----------------------••------------ ---- -- ------------- Alterations and/or recommendations:_.-__ . - ---------------------------------------- -••---•------------- ------------------------------------• - FINAL INSPECTION 8Y:_-_-._ -_ - � ` •-- ---� • -- --�1 Date----- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American St 300 Woc1 Oak Street 124 Sycamore Street ZOS Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9 9 REVISED 8-59 8M 5•61 ATLAS f/