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rvrcvrril-t Ubt: --------------------- --------------------------------- ------------ ---------------------- ---- --------------------------------- APPLICATION FOR SANITATION :PERMIT Permit No. ._.. .... 2-- {Complete in Duplicate] l /� -- This Permit Exi Dires 1 Year From Date Issued Date Issued / Application ---. ...----!_•-••-•- is hereby made to the'San Joaquin Local Health District for a permit to construct and install the work herein This application is made in compliance with County Ordinance No. 549, described. 1 JOB ADDRESS AND LO . TION.: - --••---- -..1 . �_ . Owner's Name________ _____ --•. •---- - ------•-_---- -------------------------------------------------------- Phone. . ---_.. Address - - ----•------ -------------------- - -- ----------------•-----------•----------------------•-............................... Contractor's Name __ ---- -------------T ---------------------------.---------•- --- Phone.----••-- Installation will serve: Residence A, Apartment House ❑ Commercial ❑ Trailer Court �l ❑ Mote! ❑ Other ❑ Number of living units: --- Number of bedrooms ._,,C= '� Number of baths __... Lot size .__ Water Supply: Public system ❑ 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 ❑ Previous Application Made: ;if yes,date-- _._____) No New Construction: Yes E] No t FIiA/VA: Yes F1 Noj TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic f 1 0 P - Distance from nearest well----4-0-----Distance from foundation__-_. ... Material -------------------•--------- No. of compartments--------------- ----------Size--------------------------------Liquid depth----- - ----Capacity...--------••--..------ Disposal Fiel Distance from nearest well---6-fl--•-Distance from founds ' n_.__ .___..._Distance to nearest lot line____----- 1 Number of lines__�_.___.f___-______ Length of each line.___ - '� g +�__ Width of french-----,' - ---------------- terial- Depth of filter material_--.- -_, _- --Total length----•� ------ Type of filter ma b �I Seepage Pit: Distance f nearest well_______---------------Distance from foundation_..-.-_--___-....__.Distance to nearest lot line__...__._-_____-- ❑ Number of pits---- -----------------Lining material-----------------------Size: Diameter---------------------•. _ Depth-----------------•------------- Cesspool: Distance from nearest waft_----------------Distance from foundation--"._.____.____.___.Lining material____.__-__..._.__._____-_ El Size: Diameter_ {! •-----Depth--------------- Liquid Capacity Priv _ 9als. Y� Distance from nearest well----------------------------------------- __ Distance from nearest building { ❑ Distance to nearest lot line----------------- -----•--_--- Remodeling and/or repairing (describe):_---_- - -• € ----- cz ---------------------------------------V----------------------- ----------------------------------------- ---------- ------------------•------------------------------------------------------------------------------------------------------------------------------------------------------•----------•-----•-------------•----------------- - 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 rules and -regulations of the San Joaquin Local Health District. i (Signed)_A-•----•-------�N------� ----=- , -- "-----"--------------------- (Owner and/or Contractor) By:--------------------- ------ € (Title --------------------------------------- _ _ _ _ _ _____ (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., canbe placed on reverse side), FOR DEPARTMENT U$E ONLY APPLICATION ACCEPTED BY_ F DATE ................. REVIEWED BY--------------------- -------------------------------------------------------------- -............................. --------------- ----- ---- DATE------ BUILDlNG PERMIT ISSUED ---•-------------- r ----------------------------•-------•-•-- DATE. Alterations and/or recommenddations - - -------------------- ---•----•---- FINAL INSPECTION BY:. x— - Date-------- -------------------------- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Well Oak Street � 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Calffornla ._= Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS ,a r