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FOR.OFFICE USE: er, ��4 -IV, -/S �-(,,.3 <S . . � -- ------------ �:_ff-^�-?.... ,��, APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _._ -----------------------._--_._.__.----------------------- This Permit Expires 1 Year From Date Issued ___....._ _. Application is hereby made to the SanJoaquin Local Healfh District for a permit to construct and install the work herein described. �- This application is made in compliance'with County Ordinance o. 5 . JOB ADDRESS D LOCATION--eelr . -•--- . -----•-=------------------- -------------------- -- Owner's Name ------� - - ---------------------- --- Phone� _5 ,rl Address------. ------ --•-•--------••••------------- ---------------- ---- • --- -....----- ------------ -------- 7� >f' _ Phone. .__ ! Contractor's Name__-_ --- t � Installation will serve: Residence ©partment House ❑ Commercial-❑ Trailer Court [I Motel ❑ Other ❑ f � Number of living units: _�Zmun'ify ber of bedrooms _umber of baths /.__ Lot size -___-/_-?-._.__..:�__�_� ..._.. Water Supply: Public system system ❑ Private ❑ Depth To Water Table t!;�d ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam E] Clay ❑ dobe ardpan C] Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septictankor cesspool permitted if public sewer is available within 200 feet.) Seis lac Distance from nearest well_________________Distance from foundation__._.__-____._...__.Material------------------------------------------------- � No. of compartments--------------------------Size........ --------------------Liqude jh -----------------------Capacity...----------------- sal Distance from nearest well_�.�-�_Distanee from foundation_. ________ ____-Distance to nearest lot line______i�-____. Dia Number of lines-_-.1____ ------- _ Length of each line, Q-__*----------Width of trench.- Type of filter material_{ c�s,Iu___Depth of filter material...- �!____Total length--..... ------- Q----•-- ` `� - __Distance from foundation___�,e-.Distance to nearest lot Seepage P ' "Distance to nearest welL_.f`�_ Number of pits.____---------------Lining material_ �.a.k.----Size: Diame p-_ .......Dept h----C - --------------. - r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___.-_____.._______--__-_______....._ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity.--------------------------gals. 4 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------._________---_____________- ! ❑ Distance to nearest lot line--------- ---------------------------------- ---------------------•-- ---------------------------------------- ------•----•---------------- tt' i 1 Remodeling and/or repairing (descrihe�: ------••-------- 1 --•---------------•----------•--•--�•------------•----------• �- -----•------ -----.....--------- --- -------- -- 1 ----- ------••--•--------------------------- - --- -----.....Z.._ •----------------------- --------------•_-•--•----------------f- ----------- --------------------•-----------------------•----- ----------------•------------------------------. --------.---------------------- I hereby certify that I have prepared this application and that the work will a done in accordance with an Joaquin County ordinances, Sta a laws, and rules and regulations of the an Joaquin Local Health District. (Signed) `--..._-----{ Contractor) �:- iTitle-----------------------I-------------------- ---------------- (Plot ----- --- (Piot plan, showing size of lot, location of system in relation +611wells, buildings,7ef , an be placed on reverse side). FOR DEPARTMENT USE ONLY / DATE---- APPLICATION ACCEPTED BY - ---- om -� 1-/__ ----------------------------------- --------------------------------I------------- REVIEWEDBY--------------------------------------------- --------------------• -----------------------------------------------------__ DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------- -------------------r-----—...........-----------------------. DATE_ . AFFeratians angor re mreendations:___-- --- ` --- `�--' `fit-�-' � - �- :•.-------•• L =, �C 1�^- = 7 - --------------------- ---------------------------...-...-.--------------------------------------------------------------------------•-----------------------------------------------•---•------------- - -------------------------•-•---•---_--.---------._...------------------------------.-----------•---------------------------------------- / - - l_ FINAL INSPECTION BY:..-------4Date - ------------------ ------------------ 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 ES 9 REVISED 8.59 2M 5-62 ATLAS