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FOR OFFICE USE: !t!.'3e Permit No..-•- - .. . "-"""-- -� ---------_- APPLICATION FOR SANITATION PERMIT ------------ -------------------- (Complete in Duplicate) Date Issued ------------------------ This Permit Expires t Year From Date Issued ct for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health Distri This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANDLO ATiON.. 02' o! ----------------------- ----------------•-------_...-------••----------•---------- Owners Name____ _ ____ __ - - -----•--------•--------------- Phone---...---•-----------•-----=•---.... __ _ t Address - f Phone--------•------•--•--------• Contractors Name.-------�['- �.._.ti�'_.----...--•----1��`-:•-------------- Installation will serve: Residence [W-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: .____ Number of bedrooms __�___ Number of baths -1.- Lot size _±, k k-'S""' Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Tabl -• ft. Gravel Sand Loam❑ Clay Loam ❑ Clay [].. .Adobe(}Tardpan ❑ i Character of soil to a depth of 3 feet: Sand ❑ ❑ y A; Yes ❑ No d� Previous Application Made- (If yes,date--------------------) No New Construction: Yes �o� FHA/VA. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.), _.___..Distance from foundation-_�if�_____________Materlal__r-___." SFptic k: Distance from nearest wail_ -Capacity..._��- No. of compartments-------2---- ------Size---•--•--•--_`+3'_� Liquid depth Disposal id: Distance from nearest well-__.�---.-Distance from foundation.__4?-t-...--••Distance to nearest lot lins�. �.-_-• I Number of linesk-----------I---•----------------Length of each line-----:2--- Width of #ranch._-----'`xo "..............•--.. Type of filter material_' - -It-•---•Depth of filter material.___ Q -.--f---- -Total length--------:_0-----------•••------ -i i o �-_...._...Distance to nearest lot line__.------- ' Seepage Pi}: Distance to nearest well_"__________________"-Distance frim foundation.__..♦/_ �� Number of pits.1-----I-------------Lining materlal..-_�__ -I- -Size: Diameter__... •3_-.___.---.Depth__.__.___. r-- Cesspool: . . . distance from neares# well_______----------Distance from foundation--------------------Lining materia---------------.-----------••---•els. Depth_. Capacity----•-•---------•---- --9 t, Size: Diameter-- •--------------- p l\ I I Distance from neares# building-----•---------•----•-----------••-------- privy: Distance from nearest well-.-.--.._________ _________________ Distance to nearest lot line__-"__-__.__."________-_- -------------------------------- El -------•----------•------------•--•-•---••-•----•---•------------•-•----•--•--•-------------------•----•---- ( Remodeling and/or repairing (desribe):_-_"------------------ - ------ { --------------•---------•------------------------ YY -------------------------• •- - -----------------------------------------------------------------•---------•------------•------•--------•------------------------------- e work done inancreb ter ify that and Ihave par Mations oI' the San Joaqui hLocal Heall#IteDistr {� accordance with San Joaquin County ordinances, "--_,___..[Owner and/or Contractor) Title ey� { ' ) ------------------------- ------- - (Plot plan, showing siz o lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f --------------------- FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- 'r.`"'.� - __ DATE------- y- +� ---- •---------- DATE REVIEWED BY_... --- -•----. DAT BUILDING PERMIT ISSUED--- ------------- i Alterations and/or recommenda{ions:. ------ ,7- - 1� --------- ------ ................................. i ----------- ---- ------- ....... -- .............. ------ --------------------------------- Date ----.•--• ----- ' FINAL INSPECTION BY:_._."_ ._____ N JOAQUIN LOCAL HEALTH DISTRICT I 205 West 9th Street 130 South American Street 300 West Oak Street 124 sycamore Street Lodi,California Manteca,California Tracy,California Stockton,California •' ES 9 REVISED B•59 RMf 5-61 ATLAS '