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FOR OFFICE USE: � 1�t q -b ^i �1 q Z/a --------------------------------------------------------- `-( K� // --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...�.. ...!' ------------------- ------ ------------------------------ (Complete in Duplicate) . .---.--- This Permit Expires 1 Year From Date Issued Date Issued -....,...Zz 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 O ATIO T......................... 5_. nC '. Owner's Nam ............ �. ........................................................ __ Phone......................•.• . . / / --------1111-- ------------•1111-•-----------•1111--1111-- -- Address.-----..- ;...... ... t- --------------r-- --•-- Contractor's Name............... •------•---•----- Phone................................... Installation will serve: Residence Apartment House C mmercial ❑ Traj r Court ❑ Motel ❑ Other-❑ Number of living units: _�..... Number of bedrooms umber 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 ❑ r Previous Application Made: (If yes,date--------------------) No ❑ New Constru io s No E] FHA/VA: Yes ❑ No ❑ 1' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation....................Material............... ................................. ❑ No. of compartments--------------------------Size................................Liquiddepth..........................Capacity.........�.�... Dispo al Field: Distance from nearest well_100......Distance from foundation... . ___,,._Distance to nearest lot lire...- 1111-..... Number of lines__._.4:2..._____..1�1�11-__r1111._Length of each line.�¢_�____-�L_J__.._.Width of trench___.. _� Type of filter material_ .r&C*.__._Depth of filter material _D_ .......Total len th_1111p �® P --O 9 =/-•�--•---....1111----•--• Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. Q ❑ Number of pits______________________Lining material-----------------------Size: Diameter.......................Depth................................. O Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material..................................... ❑ Size: Diameter......................................Depth...................................................Liquid Capacity............................gals. Privy: Distance from nearest well------------------------------------------------- from nearest building.......................................... ❑ Distance to nearest lot line------------------------------------ ------------------------------------..................................................................... Remodeling andZQr repairing (describe):------ !1111•-- "�"'--- --- y/ems- --D�- "�,-.'----x----- --------------•--------- --u---------------------------------------------------•---•-••--•---------------------•...... --•--------•--------••---------•---------••---•------••-------------•------•-----•-------•----------------------------------•--•------------------•------•---•-----•--------•-•----•••--•------------------•------•----•----- I hereby certif that I have prepared is application and that the work will be done in accordance with San Joaquin County ordinances, Stat '�ws, hd rules and r gul tions of the San Joaquin Local Health District. Si nod 1 �r"f ' ..............................................(Owner and/or Contractor ( 9 )- ..---- ...--1111-- - -= ---C,�.-�-'-- JIV' By: .._.. - --------------------------------------------------------------------------- lT'itle) (Plot plan, showing size of lot, loc on of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY a APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE.......................... ------1111-------------....---- REVIEWED BY.................................................................. - -- - . DATE-----g�111 lJ T7-- --�, -�'-----------------1111-- BUILDING PERMIT ISSUED............................................ --- -- -----.................................... DATE------------------------------------------------------------ -------------------------------1111-- Alterationsand/or recommendations:---------------------------------------------------------------------------•-------•-----•------...-•-------.-...._._...---...--•--•--••-----•---...-----••--•- FINAL INSPECTION BY:............... .. . __- DateQ' '' / ��---------• --------- <� / •.4 .................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 301�West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-61 ATLAS