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FOR OFFICE USE: ---------------- ---------------------------------------- ........ APPLICATION FOR SANITATION PERMIT 4 Permit No. ...,C.�ll ------------------------------ ------------------------- (Complete in Duplicate) r -..-_ -- ---------------------------------- -------------- 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 herein described. This application is made in compliance with Co my }rdinance No. 549. 003 "710. Z;uj r, — - - ----------- - -- P,/ JOB ADDRESS AND C ! Gf�-- - CacCPJi { F r - Phone... - ... Address---------- - �' "- caner s. ame... --•----------•------------------------------- Contractor s Name. ------ x'� Phone........ Installation will serve: Res clence I Apartment}House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..-__ Number of bedrooms �Z-- Number f baths --/--_ Lot size -------------------------------- F Water Supply: Public system ❑ Community sytern ❑.'Private Depth 'Water Table ----___ ft. Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy LoamClay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ i Previous Application Made: {If yes,date---_'_"-T-- `--.:7 'No [:1New Construction: Yes E] No ❑ FHA/VA: Yes E] No ❑ A ` TYPE OF INSTALLATION 1�AND SPECIFICATIONS- (No-septic PECIFICATIONS:(No:septic tenk or cesspool permit+ecNf public sewer is available within 200 feet.) Septic ank: Distance from nearest well--_---�V...Distance from foundation.-.-l-t-------.Material---- -- -------- ----------- ------------------i , No. of compartments----------` ----- ---Size--Y_g. ./-(�_-$.Liquid depth---- ._-j----------- Capacity-- - -- . Dispos Field: Distance from nearest well.._. --�.-Distance from foundation---- .---Distance to nearest lot.line---r _ Number of lines---------/------------------ ----Length of each line......../-0--0- ....Width of trench----7-. .. Type of filter material.-Ad Depth of filter material........./-L?-`Notal length_.-..-J-.0-4 -- -------------------- 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------------------------------------- El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-- ••-•-•--------------..gals. Privy: Distance from nearest well---------------------------------_.-------------Distance from nearest building------------------------------------------. �+ ❑ Distance to nearest lot line------------------------------------------------- --------------------- ----------------------------------------------- '-------------- G Remo - n or repairing (describe):---- ----------------- --------- ---------------•-----------•------------•----------------•--•-•-••---•----............_...-------------------•---..._ , ---•----•----------------•----------•-------------•--• --------------------------------------------------------- ----------- ----------------...__.-.-.---------------`----•--- i -------•------•----•---------------------•-----------------....------------------------•-•----------------------------•-_.......•------------------------------------------------;------------ ••---------.-.....-------- -----------------------------•------------••------------ ••-------------------- ------------------------------------------•------------------------•--------------•--••-------------•-•-•-------------------- - ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San-Joaquin County 1 , ordinances, Sta&law , rules and regulations of +he San Joaquin Local Health District.(Signed).--•-•-•-... .......... ei12afion -- ----- ---------- -••----------------------------------------------{Awmn-bnd/or Contractor) By:-------- •• -- -----------------------------------(Title) ........... (Plot plan, showing size of lot, location of system tow IIs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----------------------------------------------------•-•-. DATE..-L?-.` '_G? ----------------------------- REVIEWED BY--------------------------------------------- ---------------------------------------------------------------- --.--- DATE------------------------------------------------------------ ( BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------------------------•------• .LN): Alterations and/or recommendations:--------------- ------ --- ------------------------------------------..-..-------•-------------------------....-----------•-•-----------------.--------------- ------------------------------------------------------------------------------------------------------------------------------------------------------•--------------•-----•-------------------------------------------------- --------------•--•--------------------------------------------------------------------------------------- ---------....-•-------------------------•--------------•-•------••-------•-- ------------------------------------ ; 11�FINAL INSPECTION BY: - O' i''------------------- ------- 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 ES 9 REVI5ED 8-59 2M 5-52 ATLAS