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FOROFFICE USE: i. -.---._--------------------------------------.---------- APPLICATION FOR SANITATION PERMIT Permit No. _�_._ ----------------------------------------- --------------- (Complete in Duplicate) //JJ �— This Permit Expires ] Year From Date Issued Date Issued T�_ __- 7i Application is hereby made to the San Joaquin Local Health District for a permit to construla and install the work herein de This application is made in compliance with County Ordinance No. 549. �f rel �✓J f ` JOB ADDRESS AND LOC TION .. _ __. .. !+�- --------------------------------------- OSQ—�Y�G?.-[ Owner's Name . .- ------------ -- .... ---------------------------------------------------------- Phone----------------------------------- Address---------- - .... Contractor's Name--- ----- -------------- -•------••-----------------------....--------------------------------------------------------- Phone................................... Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: x �....-- Number of bedrooms _�--. Number of baths __�-=:. Lot size __-�a"t?.�--��'............................. Water-Supply: Public system ❑ Community system ❑ Private ,M Depth.to Water Table 3R ft:' Character of soil to a-depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam4 Clay Loam j@ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No (4 New Construction: Yes M No ❑ 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--. _...Distant fro foundation__-=� :"'__.M -fee ria)... .: . ...................: .:..: �*°—" No i of compartments....x------- -------Size-' yf__'�- ----, Li uid de h-..--_- ----_._._. Ca aci : q P --- Disposal Field:' Distance from nearest well__Xa--------Distance from foundation----A2..........Distance to'nearest lot line........-___ Number of lines E ��t._ _ (Length of each line--__--4..................Width of trench...-��'...-- ---------- .... N ,Type of filter ma ria) - r E-_Depth of filter material---- ---------Total length-_,�-AIO-_'------------------------ Seepage Pit: Distance'to-nearest well----------------------Distance from foundation----.___---.•-..___.Distance to nearest lot line................. lh F1 Number of pits----------------R----Lining material--•--------------------Size: Diameter........................Depth----------------_----_. i , Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------------- ElSize: Diary�ete�= =..-- �--- = Depth P ------------------------------Liquid Capacity------------------.........gals. Privy: .Distance from nearest well-----------------------------------._------------Distance from nearest building-------------------......____----------.-. ❑ Distance to nearest lot line---------------------------------------------- Remodeling and/or repairing (describe): - ----------------•-----•-•-----------------------••-------------------------------•------------•---- u t --------------------------•-•----------------------••-----•- ... --------------------------- r; - --------------------•------------------------------•---- - ------------------------------------------------------------------------------------------------------------------••--•--------------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Q408 laws, and rules and gulations of the San Joaquin Local Health District. (Signed)------ _1L1------7...... ----------------------------------•---------------------------------(Owner and/or Contractor) By --•----------••--•-••-- ------------------------------------I------------------------------------------------------....(Title) (Plot plan, s owing siz of lot, location of system in relation to wells, buildings; etc.,can be-'placed on-reverse side).- -- Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. -- -- -�---------------------------------------------------------- DATE_ - - REVIEWED BY--------------------------------------•----- ---------------------- ------------ ----------------------------------------- DATE---- ----------------- BUILDING PERMIT ISSUED------------------------------------------------------------- DATE.-- Alterations and/or recommendations:------------------------------------ --•-•------------------------------------------•------••---------------••-•----------------------------- f -------------------------------------------.......-----------------------------------•------------------------------------------------------------.--------------------------------------------------------------- -------------------------------------•-•------------------- -------------------------------------------------------•-------- -------------- ............. ---•-- ------------------ + T - FINAL INSPECTION BY:.. _--------- ' -------------------- Date--.... --. = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Weil Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 EM 5-6r ATLAS . +