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FOR OFFICE USE. -------------------------------------------- ------------- p ------------------ --- ----------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. .../� - - (Complete in Duplicate) Date Issued ---- -- - ` -------_----.--."""-"--------------- __ This Permit Expires 1 Year From Date Issued �! __O 90 -p{Q 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 A D LOCATION. - --- f --- ''"'� Owner's Name--.- t_.. a..... •---- ----- - ---------------- -------------- Phone............................... ---------7_1 ------ ----- -------- .-- --------------------•----------------------------------- --•-------------••-•-•---•••-••------••...... Contractor's Name------•1•. •-- ------- ---------------------------------•--••------- ---•--------------•-----•------------ ....... Phone----------------------------------- Installation will serve: Residenc Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel%❑ Other ❑ Number of living units: ..----- Number of bedrooms .Number of baths ---I... Lot size ...r/- Water Supply: Public system El Community system El Private Depth to Water Table; .'p""ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe P/ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No K New Construction: Y s No ❑ FHA/VA: Yes C] No,�" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic t nk or cesspool permitted if public sewer is available within 200 feet.) 1 f 5e*ti -TanI---- "� fence from nearest well._.__-______-..Distance from foundation_________----------.Material------------ .............. _.._...._._._. lif compartments--------------- �r Size------- _---------------------Liquid depth--------------------------Capacity-----------••--•�-- Disposal stance from nearest well..70-------Distance from foundationn../.�Xr ____Distance to nearest lo+ line_........... W ' mber of lines--------- __________ Length of each line.-----949 Width of trench_____,r —��_------___•--- 4� Type of filter materiaL•.�_1---}"Depth of filter materia ........ length_____ ............................. Seepage Pit: Distance to nearest well----------------------Distance from foundation........------------Distance to nearest lot line................. ❑ Number of pits----------------------Lining material.----------------------Size: Diameter-----------•----------.Depth--------------------------------- Cesspook: Distance from nearest well__---------------Distance from foundation--------------------Lining material•-______-_-___-_._..___________----I.. i ❑ Size: Diameter---------- --------•-Depth---------------------------------------------------.Liquid Capacity.....---------..------__....gas . :._.. 4 - Privy: Distance from nearest well_____________"_""_________"__..____._---.- -----Distance-from nearest building------------------------------------------ Distanceto nearest lot line----------------------- ------------------------ ------------------------------------------------------------------------------------------ ---------- Remodelin and/or reps- i g (describe):___ _____. , q. .4------------------------ ----- ---- --- -- �. ---------- ----------------- = ::--------- ------ - :::::: I hereby certify t have pr ared this application and that the will be done in accordance with San Joaquin County ordinances, State laws and rules �anfd regulations of the San Joaquin Local Health District. Si reed �/ �� i'e''.`'ta' _Y_i `------------------------------------------------- •-------------------•-------- ----------(Owner and/or Contractor) ( 9 ) -•------.._..I. By:----------------------------------------------------------.----------------------------------------------------------._....-----....(Title)-------------------------------- ------------- -- -------------- ._ (Plot plan, showing size of loft, location of system in relation-to wells;buildings;-etc., can-be-placed-on-reverse-side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ----------------------------------------------------------------------•---------- ..... DATE --------------------•- REVIEWEDBY--------•------------------------------------ ------•------------- DATE-- --- -� ------ -- BUILDING PERMIT ISSUED.------------------------------------ � ..-•------------ DATE Alterationsand/or recommendations------- ------------- --------------------------------------------------..__-----••----------------------------------------------------- --------------------------- -------------------I--------- --•------ ------- ------ -----------------------------------------------------------------------------------------------•------....... FINAL INSPECTION BY----------- ------- ------ ---f - Date--------•--•-- •• �. ------•--••--- SAN JOAQUIN LOCAL HEALTH DISTRICT _- 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r ES 9 REVISED 8-59 YM S-61 ATLAS