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FOR FFIC�I �'� 1�� ..............__f.------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. �5 ----------- ----------------- -------------------------- (Complete in Duplicate) ../ Z ...� ----------------------------- --------------W------=------------ I This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the Sen 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. JOBADDRESS AND LOCATION.. � _2 -----------•----------------------------------------•--•------------------------------------------------ Owner's Name.... ..... ----------- ----------------------------•----------------------------------------_------------------------ Phone------------- -------------- Address `z. . ` ' `'' ----------------------------------------------------------•----.-.....------------------------•--••------------•-•----------------------------- Contractor's Name ----`-�-7--`-------•-----•---------------------------•---...---------------------------------------------••---- Phone.................................. Installation will serve: Residence [5'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .__1--_ Number of bedrooms _:e.. Number of baths _1--- Lot size ....xw,�t.__ __-T-?' . .......... Water Supply: Public system [T Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth.of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan 0 Previous Application Made: '(If yes,date--------------------) No New Construction: Yes 2--No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well---- ------Distance from foundation/P---------------Material----_I-Ce .-..__._. ........... No. of compartments----- ----------------Size_... ._9't_�x--`___,...Liquid depth----�--`----•-------- Capacity._.3U-0.y -. Disposal Field: Distance!from nearest well.-.-- ---------Distance from foundation--_4Q............Distance to nearest lot line.4._... [� Number'of lines----------I-----------------------Length of each line......gzP.-..-`-----------.Width of french.----- Type of filter material...:_�.G_�-------Depth of filter material../B'''-____--__-Notal length....... ................----------- Seepage Pit: Distance'-to nearest well_____________________Distance om f undationl6._._._...._...Dist nce to nearest lot fine.....__._ 0' Number of pits-_-.-__I_____________Lining material. .; ... - ------------- Size: Diameter-------- ----�------.Depth------.2�'_..--------- Cesspool: Distancefrom nearest well-----------------Distance from foundation--------------------Lining material__-------__--_-----_-----. -......_. ❑ Size: Dia;meter--------------------------------------Dept h----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------:_--_-----__ ❑ Distance to nearest lot line---------------- 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, State laws, and Ovules and regulations of the San Joaquin Local Health District. (Signed)----------------------------------------------• ------(Owner and/or Contractor) BY: -- ---------- ---•-•--•--------------------------------------•-•-- .....(Title)---- ....-----------------•------------------------------•---- (Plot plan, showing size of I oca ton of system i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- DATE--- �...-...2.7- � -�------- REVIEWEDBY ---------------------------- - -------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED-- ------------------------------------------------------------ ... ------------------------------- DATE------------------------------ ------------- = A5!ryion%and or recommend tions:---------------- --------- ---------- ----------------- C —r .L .,( �_� �_ -- ---..._------ ----: - a-------------- � 11 �- _--- - . ...tom- 4 ---------- �.. c7- F1NAL INSPECTION BY:,. -=-- --` --- --- ----------- - Date---- ------------..7-----------------Z------_-- ---------•-•--•----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED 8-59 2M B-61 ATLAS