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FOR OFFICE USE. R4 ,2 -------- ----------------------------------------------- I' ' �} `APPLICATION ,FOR SANITATION PERMIT ��ermit No. ...��!-�._.._ --------------------------------------------------------- (Complete in Duplicate) 4;-Date ---_.__---_-------------------------------------------- This Permit Expires 1 Year From Date Issued Issued ...,.. �. Application is hereby made to the San Joaquin Local Heal+h District for a permit ti l i5a construct and instalwor rein escrbed. This application is made in compliance with County Ordinance No. S49. r...._ JOB ADDRESSNALOCATION.-...- --------- -- ------------ -------------------.......---•-----•-Owner's Name- ...__ -- -•-------------- Phone------ Address------------- 0.••. , ------ --- - -:,� 1. w Contractor's Name----------�� ' f`` -� ...__.... ------------- e............................. Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel F] Other [3Number of living units: __I____ Number of bedrooms __'Z—Number of baths�__L_7r'Lot size ...... Q_f_.. ....z.. ............... Water Supply: Public system ❑ Community system ❑ Private or Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam 1f Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,dote--------------------1 No ❑ New Construction.: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within-200 feet.) SPpf'c �nk:oPDistance from nearest well-----------------Distance from foundation-------.-----------.Material--------------------------...................... No. of compartments---------- _______________Size____....______________-.--__,_--Liquid depth---------------------------Caaci Disposal Field: Distance from nearest well--- ____Distance from foundation._... .U_______Distance to nearest lot lig----S....... ❑ Number of lines-------------I----------_ .___ Length of each line--------- ---------Width of trench.__ __ .> Type of filter material-_-, ._Depth of filter material-------l_ _________Total length__________ _ _____ ............ Q A Distance to nearest well--- _W_._________Distance fro foundation----- .........Distance to nearest lot Iine.10__.__.___.. Q ❑ Number of pits---...1--------------Lining material- Vf-----------Size: Depth____...�-------------------- �1 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___.________-______._---------_.----_ ❑ Size: Diameter---------;-- •-------------Depth--------------------------------------------------._Liquid Capacity------•-•--•---------------gals. Privy: Distance from nearest well-____________________________________.__ -------Distance from nearest building.......................................... ❑ Distance to nearest lot line--------- --•- ------------------ --- -----�--y----••--•---------- -------•----•-----------............................_............. Remodeling and/or repairing (describe):------ X # ----:-- '!`-----`_' __k __.-.._-- -•-- �r�-•---s-----------•-•-----•--- -------------•---•-------------------•---------------------•-••-•---------•-------------------V -----------------•----------- --- -------- ------- -- --•--....._..._..---------------- ----------------•-•----------------------------••---•------•---•----------•-------•-----------•---•---• .... ..------•-------------------•-----------------------------------•--------.----••-----------•----•-•---•---.----- --•--------------------------•------ --...------------------------------------•--------------------------------------------------•-•---.--•-•---•--------------------------------------------_---------------------------- 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 rules and regulations of the San Joaquin Local Health District. (Signed)------- ----Ilk------ --- ----- ' --------------------••---------------•-•----- -- wner and/or Contractor) (Plot plan, showing size of lot, location o�ffsyysfem in relati n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ -- ------------------- DATE-...- --------------_------------ REVIEWED ------------- -----. - REVIEWEDBY---------------------------------------------- -•----------------- ••------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------•----------------------------------------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations:---------------------------------------------------------••-----------------------------------•-•-•-----------.--------•-••--•------------•--........... -------•---•...............•-----•-•------------------------------•---------------------------------------------------------------------------------------------------------....---------------------------- ---•-- -----------•-------------------------------------------------------•----------•-------------------------- ---------------------------------------------------------------------------•---------------------------------------- FINAL INSPECTION BY: 2,R. + Date---I- ------------------------------------------------------ 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 5 REVISED B-59 2M 6-61 ATLAS ��