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FOR OFFICE USE:11 r Y --------------•---------- -------------------- APPLICATION FOR SANITATION PERMITPermit No. ...._ ............... ------------------------ ------------ ----------- (Complete in Duplicate) Date Issued v— l -------- ----------- This Permit Expires 1 Year From Date Issued ----••-------_U-�-- � Application is hereby made to the Sari[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 LOCATPN_-------------------------•--- _:�y------------------------ Phone,Name------•----------------�j C. -------e/' Address-------•-------------- - =---------•----••--_- -----•-•--•--•--------•-------------------••--•----- +4 Contractor's Name---------------------- ............... Phone---------------------••--•------•- ----•--------- r Installation will serve: Residence Apartment House Commercial Trailer Court Motel 0 Other Number of living units: . _ Number of bedrooms _`. Number of baths _]t-- Lot size _____ _ _---___-_lt-------1 _ -_.___-.- I ' l Water Supply: Public system-� Community system ❑ Private ❑ Depth To Water Table -------- it. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam`, Clay ❑ Adobe IXI. Hardpan ❑ Previous APP iication Made: (If yes,ddte--------------------) No F1New Construction: Yes E] No E] FHA/VA: Yes E] No El,t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 340 feet.) { -a Septic Tank: Distance from nearest well-----------------Distance from foundation-----._--_---_---.Material------------------------------------------------. F ❑ No..of compartments-------------------------Size--------•-----------•--•--------Liquid depth--------- ----------------Capacity--------•----------•--- i D posal Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line_---___-------•-- ' ` 7*)❑ Number of lines_ -mss`• ------Length of each line---- --•--------------------•.Width of trench-----------•----------------------- v � Typ; of felt�r'material - --•--------r-Depth of filter,materialT� �_,�__ otal length----------------------------------••-•-!•- Seepage Pit: Distance to nearest well_- ---.Distance fro,�✓a foundation......Z�'......Distance to nearest lot line--.�7._---- Number of pits--------/----------Lining material----- - Size: Diameter---- - -#------.-.Depth------ ----- --------- Cesspool: Distance from nearest well-----------------Distance from foundation------------__.,,_,.Lining materia L-.------------------_------_----_-- ❑ Size: Diameter_' ...DeptE ---------------------------'`Liquid Capacity gels. `' -.---.-Distance{from nearest building Privy: Distance from nearest well-------------------------------------- -- g--------------------------------------- ----------- Distance --------------- ---•------------------Distance to nearest lot line----------------- * F -•------ ,Remodeling and/or repairing (describe):--------- ----------------------------------------------------J t�-------•------------••-•-•----------••---------•-•---•---------------------------------- •-- •-----------_fi-- ••-------- -----•- ---- -_ _: '' 11 -----•--•------••------------••--------------------- --- ( i II 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 rues and regulati ns of the San J quire Local Health District. (Signed)------ ------------- /----- - --------- --- - ------- - --- - ------------------------------ ------------------------ ------------.Owner and/or Contractor) By ............................•. _ . z .� -- --------------------------------------------- -------------- t (Piot plan, showing size of lot, locat o system in r tion to wells, buildings, etc., can be placed on reverse side). ii ( FOR EPARTMENT USE ONLY DATE L� APPLICATION ACCEPTED BY------ -- --------------------------------------- -- --•----------- l REVIEWEDBY------------------------------------- I--- •-•------------------. DATE--- --------------------------------------------------------- BUILDING PERMIT ISSUED-----_-•------� DATES ------------------------------------- and/or r co mendations:---- ----- ------------------ . --------- ---- •• -- ---.._...... L� -- - -•• --------------------- --- ------------------------------------------ ------------------- --- -- ----= :. rs-------------- --------- --x-- ----- ------'-'-"`-- °- ----- - --�-- ---------.cry. .. -- - - ---------- -- --- �!— � c-rte at,� . - Date FINAL I SPI=C.:TION BY--------- --- _---------------- -- --------------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wed Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California k Lodi,California Manteca,California Tracy,California ES 4 REVISED 8-59 2M 5^62 ATLAS i r]