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FOR OFFICE USE: APPLICATION -FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) 8/y/ ------------ 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 work he 4in 14�. This application is made in compliance_with County Ordinance No. 549. �./'�f��{ €-, f ,+�-rte,•, ^Ci�.f' %2�'J � -�7- JOB ADDRESS AND LOCATION........ pp�� j l Owner's Name L� '" t 1�`ls e5�!'1 Pr_... •- ----- - ----------• --------------------- Phone..... . _ Address... ---------- tg,.. --------f'- ` Contractor's Name ._ --.-. -------------------- - - Phone................................... Installation will serve: Residence Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----4 Number of bedrooms ---.2,- Number of baths J_.__ Lot size ----,1 Water Supply: Public system ❑ Community system ❑ Private R—Depth To Water Table ./ ft. 1 Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date......_. ----------) No E3---New Construction: Yes B-1 4-o ❑ FHANA: Yes ❑ No ❑_ . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � i Septic T nk: Distance from nearest well-_15—IL from foundation_-./_O_._f____-_.-Material....... ---•-_-_-. a No, of compartments-_4---•-------- -------------------------------------- ..-Size------- - -�7_------Liquid depth`------�1`----------- Disposal Field: Distance from nearest well-_0-0-__----.Distance from foundation.1d._ -----------Distance to nearest lot line_C / ._--•- Number of lines.....'L_j-___.._ Length of each line---��-___-_--�- .._.Width of trench---_ ______________ Type of filter material`�1 --__-_Depth of filter material..../-_$'-.-7-------Total length-----rC7---__ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line................. ❑ Number of pits----------------------Lining material------------------------Size: Diameter----------------------Depth--------------------------------- 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 Remodeling and/or repairing (describe):--------- ----•----------------------------••---------------------------,...• ± ------------------------------I------------------------I-------------------------•----------------------•-------------------------•-------------------------•----••------------------------- -----------------------------•----------------------------•-----------------------------------------------------------------------------------•--•----------------------------------------•----------------------- ! hereby certify that I have prepared this a4atio' d }hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulationsJoaq 'n Local Health District. (Signed)----------------------------------•---------- ---- ------------ --- - -----------------•-----------------------------------------------(Owner and/or Contractor) Y: ------------ -•----- ------ ------------------------------------(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 ON rr APPLICATION ACCEPTED BY---------------------------- ---------------------------IV �� f C.- DATE__.. 0 REVIEWEDBY ---------------------------------------------- •--- ------,---•--------------- DATE BUILDINGPERMIT ISSUED-------------------------------------------------------------—--------------- !----_------------ DATE------------------------------------ Alterations and/or recommendations----------------------------- ----------------- - --------•---•----- --------------------------------------------------------------------------•--••------•-•------------•----...-------•--------••-----------------••-•- ----------------- ------- ---------------------- ------------------------------------•--------------- _--------------.------�l----•---------------•--------------•-------.-----------•-------- FINAL INSPECTION BY:-.._ ......... . ...-Gt"----- )Date---------- 1--.� lO �.-.6 -- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th St reef Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS }