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FOR OFFICE USE: � N APPLICATION FOR SANITATION-- --------�------------------------ --------. ANITATION PERMIT Permit No. ----------------------------------------------------- --------- ------- -------------------- i I This Permit Expires 1 Year From Date Issued 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 LOCATION.--- "a3 -- /. -! -- --- -- -- -- --- -----------•-----------------•--•-•-•------- Owner's Nam1.e..._. . -••--••--.... it < Phone Address------ 3 •---- —; !t �4 ._.... Contractor's Name... ----7. ----------••-•-----.------••------------------------------------------------------------------ Phone_................................ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Other Number of living units: ---4... Number of bedrooms Number of baths ----[_ Lot size ___. _ `'............................:.. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table'l—aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[1'—H-ardpan ❑ Previous Application Made: _11f yes,date--------------------) No [ New Construction: Yes �o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank 'y Distance from nearest well _ ________________Distance from foundation_______.............Material______..-__._ ..__.___.......................... �✓ No. of compartments P ----._.._Size--------------------------------Liquid depth--------------------------Capacity------••-•---._....--- __ Disp al Fiel Distance from nearest well_______________ -Distance from foundation--------------------Distance to nearest lot line.............. �� Number of lines.-----------------------------------Length of each line------------------------------Width of trench-------.....---------------•---•-•• Type of filter material---------------_---------Depth of filter material------------------- -Totallength--------------------------........... ...__ I Seepage Pit: Distance to Weare fi well_ . -t__-.__pistance from foundation__----------------------Distance to nearest lot line_____.....:... !�V _� �-----.Size: Diameter_--• 3,3-- .---..De th--------�_:,� f - Number of pits______________________Lining material. p Cesspool: ' Distance from nearest well.................Distance from foundation-------------------.Lining material-_-..__________________-.------..__._ i _Li Liquid Capacity ❑ � Size: Diameter-----I -- �--- --------------------Depth-------•------------------------- -------------- 9 -----•-••-•-•------____-___=gals. Privy: Distance from nearest well ________________________________________________Distance from nearest building------------------------------------------ 'h m ❑ E Distance to neare'f lot line-------------------------------------------------- Remodelingand/or repairing (descr6e):------------------------------------------------------------------------------•-----------------............................................. -•------- ................--------------------------------------------------....-----•--••-------------------------------------------------------------------------------------------------------____------------------------------- ------------------------------------••---------- - --•------------------------------------------------------------------------------------------------------------•----------------------------- -------------------- - I hereby certify that ha prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, r es end r gulations of the San Joaquin Local Health District. - 1 (Signed)............------------- ---- -- -- ---- - ----------------- - ---------------------- ---------------------------•- ---••-------- ---------------- (Owner and/or Contractor) By- --••-- ----------------- ----------------------------------•-------------------------------------------------(Title)---------- -------------------------- - - ------------ (Plot plan, sh wi size of lot, location of system in relation to wells, buildings, etc., can be placed-on reverse side). T fi FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ - ---------------------------------------------------- DATE---- ---------------_Z- ------------------ : .- _ REVIEWEDBY-------------------------------------- -------------------------------------------•--------•-- ---------------•------------ DATE__. .... BUILDINGPERMIT ISSUED---------------=--- ----------------------------------------------------------------------------------• DATE------------------------------ ------------- Alterations and/or recommendati $-.1 ................... ------------------------ _-V -w- - - . -i .... ----------------------------------------------------------------- ----------------------------------------------- ---------- ---------------------------------------------------------------------- ---------- „f F _---------------------------------------------------------------_---------------------______------------------------------------------------------------------------------.............____-.___.._______...._..--------------- I -------------- FINAL INSPECTION F BY:-�..._._�_.. _ . l- •�U - - � .......................... Date-•--�= - ----------- � -- -----------------�--------- --•---•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED B-59 21A 5-61 ATLAS