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FOIL OFFICE USE: 97--------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ... .. ... _...._ ------------------------------ --------- ---------------- (Complete in Duplicate) - This Permit Ex ices 1 Year From Date Issued Date Issued .._..__ Application is hereby made to the San Joaquin Local Health District for amit to con trusfa nd install the work herein described. .prThis application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN LOCATION. .,5_/-.__-__-_. /` .�?' X�.__ _ __. .___ �f— Owner's Name____ - -•------- - - L---------------------- ...------------.._. Phone.................................... � Address...... ?� 51 = ------- ------- •--•-----------------------------••--------•- Contractor's Name........... �.... ` - ---- '.......... ........ Phone....--•-•--•----•---.I......... Installation will serve: Residence Apartment Ouse ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ Number of living units. -/____ Number of bedrooms _umber of baths __/... Lot size ______ _____________• ---_ ..__...__.__--------- Water Supply: Public system ❑ Community system ❑ Private W Depth To Water Table ._ ___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ElSandy Loam E] Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------I 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.) Septic Tank: Distance from nearest well-__.:--------- Distance from foundation....................Material_____._________._---________------._.___.___.-__. ❑ . No. of compartments--------•--•-----•-----_Size--------------------------------Liquid depth--------------------------Capacity-_---------------_- Dispos .Field: Distance from nearest well--S o-�---Distance from foundation------�a.._�.....Distance to nearest lot line`.,-7 -___----- Number of lines_______._._._,____�_______`_ _ Length of each I'm e-------- -----��__..Width of trench.____ f�...._-___-____ Type of filter material--4.0--x- ___Depth of filter material_______1_�_______-_Total length________ _________•___________•-----____ Distance to nearest well---------- from fQundation....J'2--- _-_..Distant to nearest Int I ❑ Number of pits--------j------------Lining material_ '_.-Size: 6iamet2T___ _X.- Depth -_________________ Cesspool- Distance from nearest well_______________-Distance from foundation--------------------Lining material-----_______- _.-._.___._______._._-_ p Size: Diameter--------------------------------------Depth-------•-------------------------------------------_Liquid Capacity----------------------------gals. Privy: Distance from nearest well__---_----.-_-------------___-___- _._ .._._Distance from nearest building__________-___________________._-..____-_. ❑ Distance to nearest lot line------------------r-----•---------------------------------------•--------.....---.....-----•----------------------------••-------------------- Remodeling and/or repairing (describe):-------- ---------------------------------•-•-------------•----------------•------------••---------------•----------............. -_------------------ -----------------------•--•-----------------------------.------•-•-----------------------------.•--------------•-•--------•-•-----------------------------------------------....--•---•------------------------------------- -------------------------------------------------------------------------------------------------------••-;-----------------------•----•------------------------------------------------------•--------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statf1s, and rules and gulations of + San Joaq ' Local Health District. (Signed) -------- - - - --- --- ----------------•---------- --- rand/or Contractor) By:............ ------• •-••--. •-•-•-••. -------!..--_...-- - .------------ ---------------(T'itle) (Plot plan, showing size of lot, location of system in relation t ds wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------------------------------------------------------ DATE----------- ----- -------- ----'/-----3---------------------------- REVIEWED BY--••---•--••--------_-•----•--------------- --------------------------------------------------------------- ------ DATE----------------------------- ---------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- •----------------------------- DATE----------------------------------- Altera+ions and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- ------------•••----•-------•-----------•------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:. ---- Date_ _- --- ----------------------------------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street j Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS