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FOR OFFICE USE. _. r 7{. 3 ._ .._ . . J APPLICATION` FOR SANITATION PERMIT Permit No. ...1...'h.'..�:. --------- ---- ------ (Complete in Duplicate) Z/ Date Issued . - --- ------------------ --- I This Permit Expires 1 Year From Date Issued .....1.....�� Application is hereby made to the n Joaquin Local Health;District for a permit to construct and install the work herein described. This application is made in compli ce with Coun Ordina-,ce-rNo 549 Y f� - ---------• D OCATION}---=•• --. -- �'. -./. . .. -- "° JOB ADDRESS AN Owner's Name-- ---- --- -------------- -- ---------------------- ------------ Phone-.......................-------- Address......... ------- Address--------- ------------------ ------------------------------------------•--• •------------------------------------------------------•.............................. Contractor's Name -----------------•---------------------------------------------------------. ..------•••• Phone---.....---------.._...../�I + Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �/Y 4 Number of living units: -------- Number of bedrooms -------- Number of baths ------- Lot size -T:-----__------------------------------------------------ Water Supply: Public system'2--Communifysystem ❑ Private ❑ Depth To Water Table -------- ft. Character of soil to a depth of 3 feel: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 02//Hardpan ❑ Previous Application Made: (If yes,date_--------------- _) No ❑ New Construction: Yes--9T"'No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) ( P P P P / i d / -----_M to i I.._./P._ F�?o'G..Z..... ; Septic Tank: Distance from .nearest weil.._�.✓_�.........Distance from foundation___._ ............. Capacity compartments..__.;- ---_--- _Size.3'{9x-�1.__,_._Liquid depth--- _-_--5L__---------Capacity i Disposal Field: Distance from nearest well-r--.-.---Distance from foundation--/. .........Distance to nearest lot line................. [�` Number of lines- ---................. Length of each line------------------- of trench......_. -' -.,----------- r --Depth of filter material-AS Total length---------- ..------:.... Type of filter material.��-___ �' Seepage Pit: Distance to nearest well_142 ------Distance from founclation_Z-0— Pistance to nearest lot Iine- .f....._ ® Number of pits.'._._l.._-----.--Lining material-_7th-- ---- ...Size: Diamet --, `L-..Depth__._.. Cesspool: Distance from nearest well-----------------Distance from foundation-----------------__.Lining material---.---.---..-_.----------------•-__- ❑ Size: Diameter--------------------------------------`Depth----------- -------Liquid Capacity gals. ! Privy: Distance from nearest well-------------------------------------------------------- ---Distance from nearest building-----------------------------------..--.-. ❑ Distance to nearest lot Iine--------------------------------------------------------- ---------------- ---------------------- ------- ------ =V W1 ------ =--------•-------------- -------------••-------------•--- - � � Ramodelin a /or reairin descri ---- -- - 1 ----•--- - -- •---• � ----� ---�d -• ........... ------------ ---------------- =••- •--------a •--•---- .... �•. --------------•--------------•-•---------------------------•--------------------------------------- ---- ---------------------_--..........=---------------------------------------------------------------------- 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 reg cations of the S Joaquin Local Health District. , //j ------------------------------------------------------(Owner and/ ays) (Signed)- = By-----------------------------------------------------------------------------------------------------------------------------------Irllel (Plot plan, showing size of lot, location of system in relation to wells,-buildings, etc., can be placed on reverse side). I FORD ARTM USE ON APPLICATION ACCEPTED BY - --------- --- DATE.--- - -------- REVIEWEDBY-------------- ---- ------ ------------------- ---• -•------- --------- DATE------------- . . .........••---• ----------- BUILDING PERMIT ISSUED----- ------------ ----------------------------- -------------------- ,— DATE ;:----------- Alterations and/or ti ona: ^'�J `' ._.... ...... l�L FINAL INSPECTION BY:.---- G7�-'-'•.✓� ---------- _ Date--------- w.....-_...L....... �`?--------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Strut 304 West Oak Street 124 Sycamore Street 305 West 9th Street Stockton,California Lodi,California v'1 m antsca,California Tracy,California _ I ES 9 REVISED a-59 2M 5-62 ATLAS