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FOR OyFjI : U E: ;.t. . ------- -------V 16,K1......S _ APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------------- {Complete in Duplicate) Date issued .___� ------------------.--- This Permit Expires I 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. This application is made in compliance with County Ordinance No 5 9. JOB ADDRESS AND L ATION.--, --- _ ----------------------------------.....................................----------------------- Owner's Name ' ---------------- Phone•--_--------------------- Address......... Contractor's Name________________ --•--•---• ------------------------------------------------------- Phone................................... Installation will serve: Residence Apartment House C] Commercial [-] Trailer Court ❑ Motel ❑ Other [I Number of living units: .___ Number of bedrooms ?_ Number of baths , ___ Lot size A6?, ........ Water Supply: Public system ❑ Community system rivate E] Depth TO Water Table �ft.e Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(�iardpan ❑ Previous'Application Pelade: (if yes,date--------------------1 No gg,--New Construction: Yes 99-110 ❑ FHA/VA: Yes &.—No'❑ 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 fa ndation---/ l [7� No. of compartments__------------------Size &-�- _494.tlquld depth_-#-� Disposal Field: Distance from nearest well----- Distance from foundation_,,1�� _._1__._ istance to nearest lot line ...... Number of lines----- Len th of.each line_ Width of trench.r _�_.. _._ • - ------ ---- -- a,.__a. .r.• Type of filter material- -Depth of filter matenaCXe _!' otal length__—I,—,.ior �______________________ r* i Seepage Pit: Distance.to nearest well____- T____Distance fr m foundation____ �.�_'__:Distance to nearest lot linet.l�__~../___._ Number of pits____._____._____Lining material_ �,�/Size: Diameter_ �7----------Depth � - -----__---- es❑spool: Distance nearest well Dfrom foundation ----Lining material - t ,Fpfh2__, YL •--_-• Liquid Capacity............... ----------•,-•gals. Privy: Distance from nearest well------------- ----------------------------------Distance from newest building___.---.__.____--_-.._____--- _-______--- ❑ Distance to nearest lot line .-:1...k ------- - - - . ti Remodeling and/or repairing (describe)_______________ _ *�" � ,�� -- 10 ----•------------------------ ------------------- e , ; ----------•-•--------- ••----------- -------•-----------•---------------•------•••----•-•---------------• ------------------ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and res and regulations of the San Joaquin Local Health District. (Signed)- -------- ------------ --- -------------- ($avner-mWor Contractor) By:-•------=-•---•-------...I--------------------- Ti+le ------ --- (Plot plan, showing size of lot, location of system in anon to wells,•building`s; etc., can be placed on reverse side). lit fiCIR DEPARTOT U51E ONLY } :E APPLICATION ACCEPTED -- -----• -•----------------- DATE-- REVIEWEDBY-.----------•-------------------------•- ---• --------------- ........ --------------------.. DATE------ ------ --- BUILDING' PERMIT ISSUED -----------••------ •--•-- ------------------ --;;-:;r::: ---:--. ---------•--DATE-------------_---- AFFera#ions and/or recommendations:-.- ----------------------------------------•----------•---•-------------.-.---•--.----•------------- ---------------- - FINAL INSPECTION :- - --- -- ------- ------ ------- Date__ ---------------•- SAN JOA�,C}L?!N LOC HEALTH DISTRICT - 130 South American Street ��` "�`^ 300 West Oak Street 124 Sycamore Street y 205 West 91h Street Stockton,California Lodi,Califamia Manteca,California Tracy,California ES 9 REVISED B•59 2M 5-62 ATLAS y