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FOR OFFICE USE: ---------- ------------- ------------ -----------___._._.-_:}--------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------ ----------- ----•-- (Complete in Duplicate) ------ This Permit Expires 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 wAAPOerein d@ Abed. this application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN CATION I -�''---- u 's == < ---- ,f `'`c-- .-------- - ! i- Owner's Name --- ----- ------- ---------------------------------Y Phone------------------------------- - - .. .t., ...- Address--- } - ----• - - - - - - - -- - --------------r---.... -------•---------•---•----- i c f Contractor's Name ------ Phone.............--------------------- Installation will serve: Residence E] Apartment House El Commercial ❑ Trailer Court ❑ Motel ❑ Other (' I % Number of living units: ___I___ Number of bedrooms -----_-- Number of baths .:�----- Lot size ----- ' �i Water Supply: Public system ❑ Community system [] Private dDepth To Wafter Table ------- ft. C Character of soil to a depth of 3 feet: Sand E] Gravel E3Sandy Loam 0 Clay Loam Clay El Adobe❑ Hardpan Previous Application Made: (If yes,dote........ ...........) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑',�)' y TYPE OF INSTALLATION AND SPECIFICATIONS: fi (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) Septic ank: Distance from nearest well__1%YP_..__Distanc� fro foundation_____ .0....._.Material______ ----_----- _..___Size--3.._.-` _X__ '-__.Li uid de th-_______ Ca aci Q sem -No. of compartments 4Y_ 6 q P. Capacity_ Dispos ield: Distance from nearest well.°®---------Distance from foudation----t_0_f-_____.Distance to nearest lot lines'_'*......... Number of lines- �____I---------t-------------Length of each line— f__�CL.r.. � _ ...._.Width of trench,.,.w"�,�.•---------•-------------- Type of filter material._, __..Depth of filter maters 1:____�.g°r_..._-Total length------__�-400--------------------- Seepage Pit: Distance to nearest well_---------------------Distance from fouridati n___-_-__-__-.------Distance to nearest to� ............ ❑ Number of pits----1------------------Lining material---------•-------------Size: Diameter------------------------Depth-------------.---................ J 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___..----------__----------------------- ID ______________________. ❑ '° - Distance to nearest lot line----+-=`--------------L----•------=------------------------------------------ -•------•----------------•-------••--� Remodeling and/or repairing (describe):--------- a ----------•-------•---- I ------••--------•--•----------------------------------- ..- -. --•-------------------------•-------•---•------==---------------------------------------------------------------.---•----•-•---•---------------------- ------•----------•------•---••-------------•---•-•---•----- = I hereby certify that I have prepared this application and that fhe work will be done in accordance with,San Joaquin County ordinances, Stat s, and rul4a4egulations of the San Joaquin Local.Hesith District. (Signed)--------- ------ ------•-------- -- •- ---- ------ ---- ------. --------------------------- =-------------- ------------•-- and/or Contractor) B .Y••---•• ---------------- ------ -- ----•� -------- ------•'----------------------------------------- --------(Title)---•-•--•---•------- --- -•-- ---...---------------------(Plat plan, showing size of lot, of system in'relatiodn to wells, buildings, etc., can be,placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. = -F------------------------• DATE _� �6 ---------- ---------------------- REVIEWEDBY------------------------------- ---------------------------------- ------ DATE----- -----•-----------•--•-------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DhvTE_-' Alterations and/or recommendations-------- ---------- --------------------------------------••--------------------------------------------------------------------.----..------------------------ r J •--•---------------------a. - „ s - FINAL INSPECTION BY• 1. 1 -.-------------------•------- Date--- ----- SAN JOAQUIN LOCAL. HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Weil 9Th Street Stockton,California Lodi,California Manteco,California Tracy,California E5 9 REVISED e•59 2M 5-62 ATLAS