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FOR OFFICE USE: -------•------------------ --------------- ------------- a -------------- ------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. .. �1__ --------------- --------------------------------------- (Complete in Duplicate) Date Issued co S1 ---_--------------------------------___..______-_._._ 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 descr e . This application is made in compliance with County Ordinance No. 549. ��0� JOB ADDRESS AND LOCATION.... _.�'' ?rLt ! X'xl--_-_--- •- - Owner's Name........ ------ -------- -------------I---- --• Phone------------------------------------ Address........................ ____••-------------•----•--------__Address-----------------•---•-• ------- ------------------.....................----------•---------•---•--- Contractor's Name----14P_��h?- -------------------------•--------- --_----------------------------•--•-----•--------------------.---------------- Phone................................... Installation will serve: Residence [] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1______ Number of bedrooms a------ Number of baths -1..... Lot size --q_3 la�'k.......P l_I--.2.o. ..._ Water Supply: Public system [I Community system ❑ Private N] Depth To Water Table _4440_ it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Oa Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: {If yes,date--------------------I No•ID New Construction: Yes Q 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_________________bistance from foundation--------------------Material____:_.__-_____.__-...-...-......_.........__...- ❑ No. of compartments--------------------------Size-----•------•-•-----r----------Liquid depth--------------------------Capacity--------------------•-- Disposal Field: Dis from nearest well___ b Distance from dation.4 Q'__-_.__..Distance to nearest lot line_,_...._._.. umber o ---- Length of ach line._. .. -91---------- _-Width of tren -Y__----------------------- Type of filter materia] _ - Q __De filter material___-_l9_q_---. _ len ____ ____._._____.___________________ 4: Distance to nearest well---%Z0_*__________Distance from foundation__/_. ..........Distance to nearest lot line_______- _ Number of pits___-t----------------Lining material.�t ---------Size: Dia meter-�� f�-------Depth---- ---__________. Cesspool: Distance from nearest well------_____......Distance from foundation-------------------- material____-_-__-__________-_______-________ ❑ Size: Diameter--------------------------------------Depth-------- -------------------------------------------Liquid Capacity..............--------------gals. Privy: Distance from nearest well-----------------------------------.----- -------Distance from nearest building____--________________________________- ❑ Distance to nearest lot line------------------------------------- ------------------------------------------------------------------•--------•------------------------------- Remodeling and/or repairing (describe):_!_ _. -! --__-1-- t!' B?�"�t____--r-_.___, . � _._ ------------- ----------------•------•---------------------------_____-----•-------•- -- ------------------. ---------. - -----------------------------------•--------•-------------- --------------------•------------------•----------------------------------------------------------•------------• --------••-----•------------- --- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, St a laws, and rules and regulations of the San Joaquin Local Health District. ___________________(Owner and/or Contractor) By:------------------------- ----------•--------------•---- ---------------------------------•----(Title)----------------------------- -----.--. - - -------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - -- ------------------------------------------------ ------------- DATE--- _ ---------------•-------- REVIEWEDBY------------------------•--•--------------------------------------- -------------------------------------------------••------ DATE - --------•------------ BUILDING PERMIT ISSUED---------------------------------------------------------- ---------- DATE---- •------------- - -------------------------------- - ------------------------------------ Alterations and/or recommendations:------------------ - ------------- ------- -----------------------------------------------_._.._.-------•-----------•-_-_---____............... ..........-------------------------------------------------------------------------------------------------------------- ---•--_--•-••-------------------------•--••-------•---------------------------•------------------ -----•-------------------------------------------------•---------------- ------------- ---------------------•---•-------------------------------•-•-------•-------------------•--•--------•-•---...I--•-- -------------------------------------------- --------------------------- ----- -------------------------------•-------------•------------------•--- -- ------------------------- ---------------------•------ FINAL INSPECTION BY:----��.u�`---------------------- Date----• - -- -----•------------ -------- ----------------------------------------- SAN --- -- ------- -SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 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