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FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT Permit No. ...:..........:......... --------------------------------------------------------- (Complete in Duplicate) Date Issued .l.�.�.{._ ........ -------------- --------------- ----------------------- 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. 4 This application is made in compliance with County Ordinance No. 549. Jam+ ---- -•-•----•------------------•------•----•--- JOBADDRESS AND LOCATION--•--•-•---3�--�--�---•---------------------•-------------•---- ---------------------- Phone Owner's Name----------- -----•---------•--•- - -----• - - �_ 2_74.......Address-----------•-------------------------------- --- .-- Contractor's Name----------------- --------•------- T....... Phone •--•--•-•---._.. Installation will serve: Residence �partment House ❑ Commercial ❑. Trailer Court (3't Motel ❑ Other ❑ Number of living units: ./___ Number of bedrooms __?�Nilmber of baths __I__ Lot size ----.3'�-�_, ../_-•` D----•----••••-----•- Water Supply: Public system [-Community system ❑ Private ❑ Depth To Water Table -------- ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam [�CTay Loam [I ' Clay ❑ Adobe❑ Hardpan C] IN o.•B- ' Previous Application Made: (If yes,date-----_.............) Not:T—New Construction: Yes ❑ No [ A/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from foundation__ __._--.Material.__ Septic Tank: Distance from nearest well t-- , No. of compartments..--__ 2---."--------Size__.. j __.j_'.Liquid depth____-�- ---------------Capacity------(� - I Disposal Field: Distance from nearest well-- -_^:._Distance from foundation_..__�r�..___Distance to nearest lot line____....._ _ Number of lines_________________ ---------Length of each line---•--------_V",0.......Width of trench------------A— --------- Type of filter material__ epth of filter material------- �...Total length____ _____ ••------•- ` Seepage Pit: Distance to nearest we!!_____. ._ _Distance fr foundationZ..�_r-'__...Distance to nearest lot line__.._`"?_-�r.. 4 0� Number of Its---- -_Lining materialSize: Diameter----?--?--r-.____.Depth____--„2_n3"'' P I Cesspool: Distance from nearest well-------------_---Distance from foundation_--._._---__---_.__.Lining materia___.._.--..-___..__._._.____.___els• 1 ❑ Size: Diameter---I --------•-Depth----------------------------------------------------Liquid Capacity----------------------------9 FDistance from nearest buildin Privy: Distance from nearest well9-----•--------------...------------------ ❑ Distance to nearest lot line---------------_---------------------------------------------------------------------------------- Re deling a /or repairing (descri e):__/ ------ --- ---- ------ ------ --- ---- --- - ,c.- .--..�------- - ---------- ---------- -- ----- ------------• - ---- Zrnd _ _ __�______________ ___l her certify that 1 haved this application and that the work will b ne in accordance with San Joaquin County ordinanc State laws, and rulegulations of the San Joaquin Local Health istrict. -------------------(Owner and/or Contractor) (Signed}. U ---------- ---------------------------� By:-------------------------- -- - - ------ ----------- - (Title)---------------------------------------- -- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY-------- -- _______ DATE--- -- - /` __--�,-.J�•-- -- -------- "-�" . REVIEWED BY---------------------------------------- --- •---------- --- . DATE_...---•------------•-------------••-•----------•---------- BUILDING PERMIT ISSUED---------------•-------------- ----------- DATE------•----------_-... Alteralli ns and/or recommendations:-----------------------�c.�.--------- ---•-•-------------------- ------................ --•-------•- ----------- -------------------- -- - -- ------ -- ~~�------Z, . _ _.e/---- - ---- - ---- ------------- ------ --,- - ••« _G 4p �u ` r---------•--- a FINAL INSPECTION BY:.. Date----------------- ----------•-------- CAQUINLOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Californla Tracy,California ES 9 REVISED S-59 2M 5-62 ATLAS