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FOR OFFICE USE: �— - PPLICATION FOR SANITATION PERMIT Permit No. .. I�_-...1..! -------------�--_"" .-- -------- (Complete in Duplicate) 3 �� --------------- - Date issued _______-�....7 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. This application is made in compliance with County Ordinance No. 549. .JOB ADDRESS AND LOCATION--------9 (� '-- -__"-` `-------- •-•------------- �- Owners Name-" ---•-•-••- - -•" -J� �-"-z _ Phone Address ------------- Contractor's Name----`, �' ( = -- _-•---- -�---••--•-•----•----_-------•-•--•---._--- Phone................................... - . Installation will serve: Residence 2�partment House ❑ Commercial ❑ `Trailer Court ❑ Motel ❑ Other ❑ s � i Number of living units: _/--- Number of bedrooms Z" Number of baths ./... Lot size --42f,1.,�__ _�------------------""-"""""""- Water Supply: Public system M-11c"ommuhity system ❑ Private ❑ Depth To Water Table Ap�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®"'Aardpan ❑ Previous Application Made: (If yes,dote-------------- -"-._l No UT�New Construction: Yes ❑ No Ug-"FHA/VA: Yes ❑ No R— TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Dist6nce from nearest well-----------------Distance from foundation-------------_----Material------------------------------------------------- No. __-------._---.Material-------------------------------.------"---------- No. of compartme`nts--------------------------Size-----------------------•--------Liquid depth..........................Capacity-•-----•------------•-- l op Disposal Fields Distance from nearest well__--- -�----Distance from foundation.--Ae_f_"_..Distance to nearest lot -.. ( ' ` Number of lines.-I-1 ��jj" Length of each {ine"""_� _. Width of trench ------------------------- Seepage `-------------------------- 01 ---:'--__--__--' �l Type of filter material/,��lsa"Depth of filter material.." __ Total length v Seepage Pit: Distance to nearest well-------- "-------Distance f om foundation---__ Distance to nearest lot lin`�--------- N l ®� Number of pits...-'/------------Lining material (9 -----Size: Diameter �epth�e�.._----------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------_-----"----------- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well----------------------- -------------------.-Distance from nearest building--------------------------------------- ❑ Distance to nearest lot line--------------------------------- 3 Remodeling and/or repairing (describe:"""" --- _ Ls ` -- ---------- i I--------- -------•----------- ---------------------------------------1-----------------------•---•------------ •--------••--------------------------------•------------:----•----••----------------------------------------------- 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. (Signed) ---------'� ------!40011�� ------- --- ---- ------------ --- -- �or Contractor) I itle) --- Br• I ---(T (Plot plan, showing size of lot, location of system in relati o wells, buildings, etc., can be placed on reverse side). r � FOR D PARTMENT USE ONLY ---- -• ---APPLICATION ACCEPTED BY DATE"" - REVIEWEDBY----------- ---------------------•- ------ -----------e DA7E _... BUILDING PERMIT ISSUED----------•-_- ----- — DATE....----•---------------------------------------------------- Alterations andor recommendations:"_"""" --"" _ _ ._" __" - _ -- -------------------------------------......................................---------- e --------------------•-----••---------•--•---------------------•-•---•---•----•--................----- ------•-----------•- ...............I--------_--••-_-. ----•"------`""""._..-___"_"""""""""-""-.._."_-._-""".""-"""""""-.__» ...--"_""""""_-.."""""""-_"-........ ... , ' 1 L I Cy FINAL INSPECTION 8 ---- - ------ -- ------ date"- � -•- -- - --------- --------------- f f'r SAN JOAQUIN CAL HE TH DISTRICT 130 South American Street` :4' 300 West Clak Sir 124 Sycamare Street 205 Wert 9th Street F Stockton,California A Lodi,Colifor a Manteca,California Trocy,.Californla ES 9 REVISED 8-59 2M $-62 ATLAS 1