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FOR OFFICE i u APPLICATION FOR SANITATION PERMIT Permit No. . .J`r ------------------------------------------------------ -- (Complete in Duplicate) ----------- ------------------- --------------- - This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to tlie`San Joaquin Local Health District for a permit to construct and install the work herein described. compliance This application is made in co with County Ordinance No. 549. JOB ADDRESS AND LOCATIION--. --------- Jr � N.:_. - Owner's Name ' -------- ------------------------------ Qhone.�f` .. 1 Address - - - •---- - ----- - •----------------- ---- .. .. go Contractor's Name--------- J .- - ------'- -. •-•--•------. Installation will serve: Residence [2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ Number of living units:'-,/--- Number of bedrooms ..Z-- Number of baths ._t.. Lot size -._..�.C�__f..x-----.1e ................. -Water Supply: Public systems ❑ Community system [IPrivate ®' Depth To Water Table ._ ft. I! Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe Ej Hardpan ❑ Previous Application Made: {if yes,date--------------------I No 10 New Construction: Yes ❑ No [9 FHA/VA: Yes ❑ No h TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material.....---------------.__......------_-------_____. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------- w Disposal Fiel : Distance from nearest well-----------------Distance from foundation-----......----_=..Distance to nearest lot line....___.......... Number of lines-_-------------------------------Length of each line-------•------•----•----------Width of trench----------------------------------- 0 Type of filter,material_________________________Depth of filter material_.....___g------------Total length-------._____...._._-__-__•__-_______--_-- Seepage Pit: Distance to nearest well---e''..___-.Distance f m foundation._-AP...`------Dist rice to nearest lot line___--.__+___. n s _ Depth------- f pits----------I--------Lining material__��<---Size: Diameter_____ __. #�___ r Ces�ool� D stance from nearest well_________________Distance from foundation-----I------------.Lining material....____.__.-_--____.__...-__-_____• P i; El Size: Diameter------------ ---------- ---•--Depth---------------------------------------"""_'_." Distance,from Capacity gals. ❑ from nearest well_______________ ______-__._-__ ___----__-_------Distance from nearest building---------------------------------------- Privy: Distance '' _ , to nearest lot line--------------=---------------------------------------------------------------------------------- Remodeling ------------------------ ...Remodeling and/or repairing (describe):--------1�%-'c -- -------------------------------- ----------- ------------------------------•-----------•-•--------•-----------•----------•-------•---------------------------_-------------------------- is ------ i -----.--•-•----------------------- -----------------------------•----------•-------- G 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. 6 10 u - --------------- ------------ --- - -- ------- n------------- O r and/or Contractor] (Signedy ------- w Title Plot !an- showing sire of lot, ------------------------- ----------------------•------------------•---( � ( p g t, location of system in relation to wells, buildings, etc-, can be placed on reverse side). ;i FOR DEPART NT USE ONLY I APPLICATION ACC EPTE f ----- - - ----------------------------- DATE. ��3.----------------- ' ------------•---- ------------------ ------------ DATE--- ------------------- --------------------------------- BUILDING •- ---•----------•------------ BUILDINGPERMIT ISSUED '------------------------ --------------------------------------- --------• DATE------------------------------------------------------------ eAlterations and/or recomm "da ` ..... ---. __.....----•--- ---•------•-•----------- - � r ----- -----------•-----------------------•-----------------------•---------------------------------- _ ._. --- --- = .......-----•-----••------ •- ---- •y / `� ----•--------'---------------- --------------------------•-------- .-•------._-. w - / --------.--• ----------•-- .. ----------- - ` FINALINSPECTION BY:'---------------------- --------------------- Date-------------------- ----------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street n 300 Wed Oak Srreel 124 Sycamore Street 205 Watt 91h Street Stockton,California Lodi,California �C-. Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-6t ATLAS < ,F