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FOR OFFICE USE: ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------- ---- --------------------------------------- (Complete in Duplicate) Date Issued ---- __-----------_------------------_------------------------ This Permit Expires 1 Year From Date_Issued __1... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her ' sc I d. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L AT N..V'..�L �...e.�--.-/"� �- /�_., / �_.... t _ --------- Owner's Name------_------- ----- ---•- -- . -------...-•--- ---------- Phone.. -------_--- Address - ------------------__---- ------ ------------------ •---•--•----•---------- --•-----------•----•--•-... Contractor's Name ---- %__ . Phone. Installation will serve: Residence g3— Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oth r �] Number of living units: _ __. Number of bedrooms _ ..-. Number of baths ./-___ Lot size 4P.0„X s - _______________ Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table OF0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam eClay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote-----...............) No g2' New Construction: Yes No ❑ FHA/VA: Yes Q/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s , Septic T k: Distance from nearest well__X�.:.__Distance r�qm founclation___.� __.__.._.Mat vial---- ............. No. of compartments______�________________Size_ ..X'1a_._._._Liquid de +h_..... - :Ca. acit A Disposal Ield: Distance from nearest well...,. ;19----Distance from foundation---/?......... DistanCe to nearest lot line._ ------_-- Number of lines------- Length of each line----46l1_ _--�--______---Width of trench.....zs.�______________ _ " N Type of filter material,�1a___ -____�_Depth of filter material....l _____. ___Total length----.r<IZ1_ .__._/#--�__- SeepPit. Distance to nearest well---------------------- from foundation...._________._...Distance"fio nearest-lot it ne__.�_._._ t _--- Number of pits----------------------Lining material-----------------------Size: Diameter ....._-------------Depth-----------------------------.--- Ces ool: 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):--------- .. sG2l •..r ------------------------- ,J�'�, --t------ -------- - ----------------------------- - • it_ -C_0-6:_____:____:...___:__------------ ---.�'------------------------•-•------------------------- ` 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, an rules and regula ions of the San Joaquin Local Health District. y �or Contractor) (Signed)----------- (rtle}_- - (Plot plan, showing size of lot, location of syst to relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1_DATE --^ -------- +E REVIEWED BY--------------------------------------------- • ----- DATE.------------------- . --------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommend'ations---------------------------------------------- - --------------------•--------------------------....----....--••-----------------••---------------------------- -•---.---•---------------------•-•.. -----------•------...--------------------------------•---•-•-----------------•--------------------------------------- --- ----------------------------•-------------------------------------- ------------------ ----•------------------------------------------------•- •------------------- r , • - ----- - ------ -- -----•--- --- ------ -------- -- --------------. -.-----•-- --------------------------._ ... ------------ FINAL INSPECT BY f,J Do ate.-. �."---� --^ ------------------------- •--•• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED a-59 2M 5-62 ATLAS