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FOR OFFICE PSE- ----- SE:------I&A Z-.-------��- APPLICATION FOR SANITATION PERMIT Permit No. __�.....1.�- '. -------------- ------------ (Complete in Duplicate] fa _ __ __ _ #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 County Ordinance No. 549. JOB ADDRESS AND OC ION.. �� ?' 1� f �'Y ---------••------------- --- - ------- --- Owner's Name =----- Phone Address-_.-• -- . ------ ....................................... Contractor's Name.....-• Phone.................................. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:-./--- Number of bedrooms &9-- Number of baths _/__- Lot size __ ..................... Water Supply: Public system ❑ Community system [] Private Depth To Water Table 6P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe%rlHardpan ❑ Previous Application Made: (if yes,date--------------------) No Zj—'New Construction: Yes ❑ No ®"FHA/VA: Yes ❑ No P— TYPE OF INSTALLATION-AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: y Distance from nearest well---------------_Distance from foundation___________________-Material _____________-._•._________--------._______--_-. 4)f No. of compartments---------_--- ---••-Size----•---------------------------Liquid depth--------------------------Capacity----•-------•----. --- '..____Distance to nearest lot lined' _j I Disposal Field: Distance from nearest weH----�,��Distance from foundation_. � -•---•--•-••- l% r Number of lines------- _ __ Length of each line___x '- ti-- Width of trench_.e,_ _ _____________________ �1 y� ^ Type of filter material-..,. Depth of filter material...../_f7___._....:_Total length_____ _Q___________________________ Seepsit: Distance to nearest well---___________________Distance from foundation------------........Distance to nearest lot line__.._______...... a Number of pits----------------------Lining material-----------.-----------Size: Diameter----------------•------Depth---------.--.----.--------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------.----.Lining material-----------------------------------._ F1Size: Diameter----- -------------------------------.Depth----------------------------------------------------Liquid Capacity----------•-------------....gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building------------------------------••-----•-- ❑ Distance to nearest lot line----------------- ----- -- -----------------------------....... --------------------------•---•--- -------------------------------- Remodeling and/or repairing (describF):---- ----4� ---------------- -- •---------------- - ► ---------- ------------------ ----------•--------- ------------------I----------- ---------- --------•-------• -------------------------------------------------------------------------------------------------------..------------------------------ I ---------------- ----- - 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 regulatio s of the San Joaquin Local Health District. - ----- -' -----�------------- I (Signed)-------•------_—;- or Contractor By:--------------------------------------- ----=--------------------•------ ------------------(rtle) '-------- ---- -- -------------- (Plot plan, showing size of lot, location' of system in ion to wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -------------•---------- DATE_.-1- 4�'�`� o REVIEWED BY------------------------------ -- - DATE BUILDINGPERMIT ISSUED----- ---------------------------- -•--••--------------------------------------------- -------------• DATE------------------------------------------------------------- Alterations and/or recommendations:-____-- ------------------------- - -•-•----------------- -- ------- - - --- I �--•••---•-�--•--------------•- �--°�- --- - - `V ter¢-:-k-1 -•••--- - - -��•- =L---,..,. ---ru-:- �•-•-� �-•.c�•.• ..- --_.._. .----------•-------- C -GJ ` `' x---------tl.---�-•-- T$ '.r:r.F< �_ ��:,` t-•--••--- I-----------------•--------•- -----------•---••-----------------------------•-----•----•-•-- ------------•------------ -----------------------------------------------------.-- -- ----------------------------------- ---------------------------•- -------------------------------..---•-------. -. -----------•-------••--•- ---------------------- ------------------------------------------ FINAL INSPECTION BY:-.--- ..... tet_ ------- Date...... ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strout 124 Sycamore Strout 305 West 9th Stroh Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS