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FOR OFFICE USE: ------------------ :"APPLICATION FO�It^SANITATION PERMIT Permit No. •-- � ------ ------ [r (Complete in Duplicate) Date issued ..i--•------- - -._ This Permit Expires l 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 ma a 'n compl-anceA with County Ordinance No. 549. Z`{ 0 r' ,40—b c JOB ADDRESS AND LOCATION . Owner's Nam -----------------------------------' ------------••--------••- •-- -- Phone--------------------------------- - ------ -••---------••--- ' ,(f -- Q.._ Phone..-- -----•--- Contractor's Name------- _- --- f ill serve: Residence Apartment House ❑ Cmercial ❑ Trailer Court Motel ❑ Other ❑ Installafion w p °� -_ Lot size . -----.----- ------l •--- Number of living units: ..____ Number of bedrooms __ Number of baths� � ••---•-I-• Water Supply: Public system ❑ Community system ❑ Private Depth ro Water Table . _ ft. �y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe L� Hardpan ❑ 1" Previous Application Made: (if yes,date-_-------------- -) No New Construction: Yes No E] FHA/VA: Yes ❑ No [I DID TYPE OF INSTALLATION AND SPECIFICATIONS: N (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tankk Distance from-nearest well------_----------Distance from foundation--____..____._.._---material--------._:___.-____.....___-._-_......______-___. No. of compartments---------- -----•-Size--------------------------------Liquid depth----- ------------------Capacity---- -------------- f ..__Distance to nearest vlot�e�,............... Drs oral Field: Distance from nearest well..__--�.___.-Distance from foundation___. _ Number of lines__. .-- Length of each line-.--Q__Q_- -' � %r�idth of trench of filter material - of filter material_._-__ ._�__--------Total length--------- --------------------------- Depth 3 Seepage Pit: Distance to nearest well---------------------- from foundationDis#ante to nearest lot line___-.___•...___.. ❑ Number of pits----------------------Lining material----------------------.Size: Diameter---. -----•---:-------Depth------------•-----•-----•-------- N Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-•..___._.-.__--____--------•--'als. ❑ _ Size: Diameter--------------------------------------Depth---------------------------•------------------------Liquid Capacity------------------ ---- -----9 Privy: Distance from nearest well------------------------------------------------Distance from nearest building.------•-------.----•---•----•------------ ❑ Distance to nearest lot line--------------------------------------- ----•------------------------- �J� Remodeling and/or repairing (describe)-------------------------------•-- ----•-------------.....------•------••----•-------•-----------------------•----------•-•----------- ----------•------------------------ --------------------------------------------------------------------------------------------------------•-------------••- ------- 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. i ---------- ------------------------------------------------------------- (Owner and/or Contractor) (Signed)- .- •-- ------- ! By:-- ------.. -_ Title ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY .t V APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE --•--------------------------- __ �—---------- DATE__.._ .� ,2 �-. I REVIEWED BY---------- ---------------------------------- --- L.. -- BUILDING PERMIT ISSUED----------•--••------------• - - DATE.. � Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------- -----•-- ------------- ---------------------------- ------ FINAL INSPECTION BY:-- ------ --- -------_----- -- ------------ ---- ----- Date---------- --------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Well Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,Callf-orrla r: Manteca,California Tracy,California ES 9 REVISED S-59 2M 5-62 ATLAS