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TOR OFFICE USE: ----- APPLICATION FOR SANITATION PERMIT Permit No. ... ..... ........... --------- ------------------------------------ / ------------- ----------------------------------------- (Complete in Duplicate) Date Issued _ -.-__.---____---_ -------------------------------- This Permit Expires 1 Year From 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. 21 ?j -E�2�--zf l JOB ADDRESS RELOCATION- --------- -- - ---- ---- ---- - -- '---�---- - -- -- - • Owner's Name. �_.... --------- ---- -:-- ---•----------- ----- ------- - --- --•---------------- one .._ .. Address__��0.. - - '---- -- ----•- . .----•-••--•• --•------ Contractor's Name_____. - .. - � Installation will serve: Residence.[] Apartment House [jCommer 'al4 railer Court E] Motel C] Other Number of living units: ._''Number of bedrooms - -- __�_ Lot size' - ! Water Supply: Public system ❑ Community system ❑ PrivateX Depth To Water Table _-7- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam E] Clay ❑ Adobe C] Hardpan C] ` 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.) Oq rr _ Mat ial-�__ apaci�;yj�-- ---�J-----�--..�-1+' � Septi Tank: Distance from nearest well_1 -----Distance from founcloon____ __�.-._ ._. No. of compartments-------- .-----------Size-- -?i -a--- ------Liquid depth---.._.�__ //�„Y---_.Distance to nearest lot li e.f. .- Disposal Field: Distance from nearest well-J_�C�------Distance from foundation___.. __.___ Number of lines----- ------------ Length of each line____ -C2-----,--...Width of trench A .% ----------------- Type of filter material_ -Depth of filter material----.�_S---------Total length-------,lm_�-------------•----- Seepage Pit: Distance to nearest well----------------___---Distance from foundation.-------------------Distance to nearest lot line____-.______._.._ � ❑ Number of pits----------------------Lining material-------- ------ Size: Diameter----•------------------Dept h_._---------•-----•-----•-------- Cesspool: Distance from nearest well----------------- from foundation--------------_-----Lining material--._.______.__.__-_.____..._____�IS ❑ Size: Diameter------------ -------------------------Depth-------•-------------------•---_-. ---------------:Liquid Capacity.---------------------------9 R Distance from nearest buildin Privy: Distance from nearest well--------•--------------------------------- 9 -----------••----•--•----•------ ❑ Distance to nearest lot line---------------------------------------- --------------------------------.--------------...--------------•------••------•-------------------- 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, State laws, and rules and regulations of the San Joaquin Local Health District. ' ---------------------------------------------------------- -----(Owner and/or Contractor) (Signed)---- (Title)---------------------------------------- -------------- F (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - DATE----------------------------------------------------------- REVIEWEDBY-------------------------- •---------------- ------------------------------------------------------- ---- DATE.. f :._�_,[. .- (�'�r,, BUILDING PERMIT ISSUED----•---------------- --- DATE Al'Ferations and/or recommend'ations------------------------------------------------------ •----•----------•--------------•-••------..._ --------------------•--._......----------------------------- -----•----------------------------•----------•-- f------•----•--------------•------••----- -- - -� �Date-- - z -- . - ----- ----- FINAL INSPECTION BY----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manleca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS