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-------------------- ------------------- -------------------------------------------------------- .aa APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------------- , (Complete in Duplicate) This Permit Ex fires 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. t��,,// L TION.�4�. LA JOB ADDRESS AND r �•"•- � ...... .�--.-- Owner's Name-..-- -- ------ -- ----------•------------ -------------•--- Phone--- Address----- -.-_._- ---- ••----. -•------- Contractor`s Name--- Installation ame..................... . . _ ❑ P --••---------------------------------------------------------- Phone _- . .---.��P..o- Instellation will serve: Residence Apartment House ❑ Commercial Trailer 6tM ❑ Motel ❑ Other Number of living units: -- __ Number of bedrooms _a-_ Number of baths __/__ Lot size .......... _ Water Supply: Public system ❑ Community system pP Y- Y Y ❑ PrivateX Depth roe Water Table/L?. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Cla Loam Clay - G � Y ❑ y ❑ Adobe❑ Hardpan ❑ y Previous Application Made: {If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: +, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0 f ,::.- , Septic Tank: Distance from nearest welf_S,0------Distance from foundation--- ~Material_" �_• No. of cum artments- �" �/ s _ P r --------------Size.._s X' � Liquid depth-----7 - r - ----------Capacity...��Q. Disposal Field: Distance from nearest wellIS.- "-.--__Distance from foundation._/�Q__�-- � Number of lines _ -_-Distance to nearest lot line__-�.___-.-•. �" Length of each line----��_`-----------•Width of trench.__" JV Type of filter material. _ -�c�-Depth of filter material.....,/&-_-"----Total length-------- -------` -t D.---- f 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.-----J ------------------------Depth---------------- ----•-------- ! ---------------------Li Liquid Capacity •.gals. Priv q P fiY --•----••-------••- Y� Distance from nearest well---"_...---".__._"_---"_"_-----_."_-_.".____"_-__Distance from neeresfi building line------------------------------------------------ ----••---•---"----••---••--•-------------. ------------------ Remodeling and/or repairing (describe):--__-4---4 .l � ] ----------- -------------------------------------------------------------------- ------------------------------------------------------- ----------------------------------------------------------------------------------- -----------"------------------- •----•---•-------------- -------------------------•---•-----"-----------------"------•--•-----•----------•-----------•-------•--•-------•---------"---------------- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,Afafe laws, rules and regulations of the San Joaquin Local Health District. (Signed)_._- ,, -- -- ------ -- - - -- --- ------- ---------------------------------------•-- wne r end/or Contractor) Title)----- -(Plot plan, showin _ ,. _ ( ) - -�---------------------- ---------- --- ---- � - -. Baize of lot location of system.in relatio - .o-wells, buildings,etc.,-can be placed on-reverse_side)..-.,w„_ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ REVIEWED �� l C' REVIEWED BY-".. DATE ---r- ..-. -------- -------------- ------------------- DATE--------------PERMIT ISSUED.---------•--------- ----- -------" -----------------•-- ------•---------------------------•--------------------- DATE-. t Aiferations and/or recommendations:, .-."_ _ .......I-------•--------•-- --------- -1 z - ......... 7--�------MN-K-------� 13T-.---..0,.K---►-------------` �R� ------••------- P.- FfNAL INSP N B Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore street 205 West 9th Street Steckton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-52 ATLAS f