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FOR OFFICE USE. -------=---------------------------- --- ----- APPLICATION FOR SANITATION PERMIT Permit No. t 5 ----------- ------------------------------------------- ..............._-_.---. I (Complete in Duplicate) _-----------------------_----------- ------------------ This Permit Expires 1 Year From Date Issued Date Issued .-I---- 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 complience'with County Ordinance No. 549. �,j�� JOB ADDRESS AND LOCATION - -..�✓------------ - Owner's Name .��I ------------------ '-- Phone,,I. a ....._ Address------------------------------------/` 4r'� �' ------------------------- ----------=. --- Contractor's Name-----•------------------•------�E ---•-•--------------...-------- ------------------ [3 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/--- Number of bedrooms ._ : Number of baths _Z___ Lot size -----------F-_5F---- [..-,J ------------- Water Supply: Public system 0 Community system ❑- Private ❑ Depth To Water Table 2�47 ft. Character of soil to a depth of 3 feetI Sand ❑ Gravel ❑ Sandy Loam [5-'Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date.___.._---_.-_-----) No [;I—New Construction: Yes E] No.[Q FHA/VA. Yes ❑ No 8 TYPE OF INSTALLATION AND SPECIFICATIONS: 1, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:. � Distance from nearest well_________________Distance from foundation____.....__________.Material--------------------------------------........... l j -t'/ `// . of compartments------- -----------------Size.-.-------•-----------------.__.Liquid de fh--------------- ----------Capacity p f ,------------------- g Distance.frorrl,:;foundation.._::...............Distance to nearest lot line................. Dis osal Field: Distance from nearest well----------------- er of Distan of eaI line.° =r' Width of trench.--------•----- -------._.. 1 / Nuebof filter material. -T.G____De th ��Yp ,�--- - p of filter-'rnater:al---_,/�'�.`.---Total length--------------�L'..'.•a---�i-•-•------ Seepage Pit: DistNumber of pits.-1 to reit well-__----_Lining--mDter�al_@-from foundation Riameter_---Distance to nearest lot line------------==-- -U)� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..--------.--------.----------------- rA ❑ Size- Diameter--- ---------------------------------Depth------=--------------------------------------------.Liquid Capacity----------------------_----gals. V` Privy: Distance from nearest well ___________--------------------------- ---- ----Distance from nearest building_______.._...-__________....__.__.__.---_. ❑ Distance to nearest lot line---------- -----------•------------------------------------------ ------------------••--------------•-- ------ Remodeling and/or repairing (4( scribe):___.-- i__ ._._ __ ----------rf.'f. ----------------------- �` " -_-----~ --- ---- -------------------•-------------------•-------- 1 - `:" ;. ---- �-`,^ •--'--•----------------------------•-----------••--•--------------------•--------- ti I ---------•------------•----------------------------------------:----------------------------------------------...---•-----------------------------------•--------•--------------•---•-- l hereby certify that I have prepared this application and that th ork will be done in accordance with San Joaquin County ordinances, State laws, and rules and gulations of the San Joaqui al Health District. _ C - tZ7 --- �� ---------------------------------------------------(Owner and/or Contractor) f $y------------------------------------------- I --------------------------------•-------------------------------(Title)-----------------•------------------------------- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). k t FOR DEPARTMENT USE ONLY oe i ----- �� L ' APPLICATION ACCEPTED BY------- DATE__ - REVIEWEDBY P------------=--------------------------------------------•------------- DATE----------------------------------------- ---•-------------- BUILDINGPERMIT ISSUED_-------------=-------------------------------------------------------------------------------------- DATE-------------- -------------------------------------------- Alterations ----------- Altera.tions� nd/�✓ re cGom�me'--ndatio-ns:+-t- ------------------------------�-- ----a- _-__------------------`---.-.-:-----------------•-te-----•---.-•----._..-'��.____/--_--_•-•_-_•_-_--- -- __ -_.r.- _ __ a _ ............17 - 4r - __________________r ____.______,r� ----------- -------------------------------------------- — ....... ---------- --------- ri ---•- f ----- ---- ----------- .... I � Date----------••--------- �1 ----------------- FINAL INSPECTION BY: --� •-- - --- -------- / .... SAN JOAQUIN LOCAL HEALTH DISTRICT 30 South American Street t 300 Wert Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS I � 4 F �