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FOR OFFICE USE: --------------- -------------------------------------- APPLICATION FOR SANITATION ( WIT Permit No. -------------------------------------- k — , (Complete in Duplicate) Date Issued -- -------------------------------------------- - ...... .... This Permit Expires I Year From Date Issued I ----------------------- —--------------------.. 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 h wA' � County Ordinance No. 549. JOB ADDRESS AND VA .........-- ----------------- ------------------ hone---------------------- ----- - ---------------------------------------------- --- Phone .. .... Owner's Norge----------- ... Address__._.. ---3---•---_ Q-------.._- A ---- ----- ---- ---------------------------------------- ------------------------------------------------- Contractor's Name...----- - - --- ------------------------------------------- P- hone.......----------- -------------- Installation will serve: Residence ipatment House [ Commercial [ Trailer Court 0 otel COther [ Number of living units: Number of bedrooms -j- Number of baths Lot size -- --------jae—A.04)........ Water Supply: Public system 0 Community system 0 Private X�,Depth to Water Table .. �_ 1- Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loom 0 Clay Loam [j Clay [] Adobe k Hardpan 0 6 New Construction: Yes No ❑ FHA/VA.. Yes [] No 0 Previous Application Made: (if y s,date----------- --- ----) No TYPE OF INSTALLATION AND SPECIFICATIONS. *e e tic tank or cesspool Permitted if.public sew r is available within 200 fee 1, Septic �n from foundation--------------------Material-----------------------......................... Ton a Distance from nlearesf-well------ S ize -- ---- I--------------------------Liquid depth-----------_-------- Capacity...................... No. of compartments_._.. Size" . r 9 /_ / 611iP D'0 ation....4o........Distance to nearest rpst lot Drip,...S-7... Disposal Field: Distance from nearest NW 11---24"Di ance from found, k I Length ____Width of trench.... J/j�----------------- Number of lin4s------2-—----- --------- --Length of each line--.--- typ.e of filter material. _Depth of filter materia ---------Total length---14p1--:_------•---•-••-•--•-• Seepage Pit: Distance to nearest well_- ---------------- --Distance from foundation....................Distance to nearest lot line___.....___---.-_ -- El Number of pits----------------------Lining material----------------.------Size: Diameter-----------_------------Depth---------------------------------- Cesspool: Distance from nearest well------------------Distance from foundation------------- -----Lining material------------------------------ Size. Diameter: -Depth--------- ---------------------------------------- Liquid Capacity-------------------_------gals. -- ------------------------;------------- Wn— ---------------------- Privy: Distance from nearest well----------------------------------------- -------Dist ce from nearest ISui aing -----------_ ---- _' \ Is ❑ Distance to nearest lot line--------------------------------- ------------------------- ......------------------------------------------------------------------------ Remodel,' g and/�rrepa.iring (,da-------- rr ..... _ ___4 ---1�. --- ------ ------------------------- -----------I--------------- ------- ...... -- V� .......... -------------I_—................................. ------------------------- ---------------I------------------------------------I.........--------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I—,------------------------------ 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. tSigned)... -------------z------------------------ - ------------------ ---------------------------- -_________________(Owner and/or Contractor) ---------- ----------- ---------------------------------- 0 reverse side). 1- wells, buildings, etc., can be placed ' n reve (Plot plan; showing size Of lot, location system in relation to FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --------------- ------------------------------•------•--------•-•-------•-- ------•---- DATE-------------------------•----- -------------------------- .................... DATE-------- -------------- REVIEWEDBY-----------1_-------------------------------- ----------------------------- ........ DATE--------- ------t- -------------------------- -------- BUILDING PERMIT ISSUED---. Alterations and/or recommendations:---------- ----- ------------- ---------------------------------------------------------- ------------------------------------------------------- --------I------------ ------------------------------------------------------------------------------....................................... ----------------------------------------------- ---------------- -------------------------------------------------------------------------------------------- --------------------I----------------------------- ......................... .. ..............I-------------------------------------- --------------------------------- ---------------------.................................-------------------------------------------- -----------------*---------------------------------------------------------------------- ---------------- --------- ----- FINAL INSPECTION BY:-------------- Date_-"-___..____ ----------------- ------------------------------------------ ----- . .... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Svr*et 124 Sycamore,Street 205 West 9th Street Manteca,California TracY,California Stockton,California Lodi,California ES 9 REVISED 8.59 EM 5-61 ATLAS