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FOR OFFICE USE: 9 j--14 0, /o,F o . -------------------- --- ---- --------------------------- I -------------------------------- ' APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------ EI ----- (Complete in Duplicate) ' ------------------ -- --------------------------- --- T '1�ermit 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 herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESSf'kND LOCATION------. --------------•..........---------------------------------------------•-----------•-----•--------- Owner's N -'- -- --------- --•--•--- ------• ------------------- ------•--. Phone........ -------------------- Address- -- -_---•--------_------•......... -• ................. Contractor's Name_et- Phone_* 3 ® Installation will serve: Residence Apar+me House ❑ Commercial Trailer Court ❑ Motel/❑ Other ❑ l Number of living units: -_L___ Number of bedrooms _Z__ Number of baths ___I__ Lot size ----- ___________ Water Supply: Public system ❑ Community system ❑ Private [k Depth To Water Table -0-!ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X) Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No [,X New Construction. Yes ❑ No P FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: septic tank or cesspool permiffed•'if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material.____________._______________--____:_____.___-. ❑A,f(iXl&� No. of.Gompartments--------------------------Size----- -----------------------..Liquid depth- •- ------Capacity--------•-------------- Disposal Field: Distance from nearest wt l___. Q_.___.:Distance from foundation.___f0.._.._._.Distance to nearest lot line---5___________ Number of lines---------1:_-•-- ..._-- ,,. Alength of each line----zFQ/----------------Width of trench.___.Z.'V// --------- Type of filter m'a"tetial._.- _�._`_'x.D"epth of filter material____ ? _-___--__Total length-------- n�_-_--__---------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation____._._.___....._-.Distance to nearest lot line__-_____-__-___-- ❑ _Number_.of pits--j---------- --------Lining material-----------------------Size: Diameter------------------------Depth---------..-----------.----------- Cesspool: Distance from nearest.well-----------------Distance from foundation--------------------Lining - material-_________.___________.____________ -------------------------------- -------------Li Liquid Capacity ---gals.Diameter---=--- `- - ------ - ----- De _----I Privy: Distance from nearest well_________________________________________ __..._Distance from nearest building__-__-________________________.____..____. ❑ Distance to nearest lot line ----- ----------------------------------------------•--------------•-•-----•----------- ••------ ------------- Remodeling and/or repairing (describe) W .. _____.. �2___ _ W. _________________________ ___________________________________________________________________________________________________________________________________________________________________________________ 7 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. [Signed]......:....------------------- ---- - -- ---'----------------- --- ---------- ------------------------------------- (Owner end/or Contractor) Y' — - --. (Piot plan, showing size f lot, location of syste n rely ' to wells, buildin s, etc., can be placed on reverse aide). ' FOR DEPARTMENT USE ONLY -APPLICATION ACCEPTED BY__ ____ DATE__,j0__-_"lf _r ': ---- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ .. -- ----------------�------------------------------------------------------------------------------._ DATE----------------•--•-�------ -••--------------------------- BUILDINGPERMIT ISSUED---------------#-------------------------------------------------------------------------------------- DATE------------------------------ --------•--------•............ IAlterations and/or-recommendations:---------------------------------------------------------•----•----------------•-------------------•--•---_--••-------------....---•-•------------------------- i. I I FINAL INSPECTION BY-----x --------- ---- - -- ------------- Date------Z-.i _'67------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS