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ORO I U E: ?� __._-.. -_ APPLICATION FOR SANITATION PERMIT Permit No. .. r........f..?.. ----------------- ------------------------------ (Complete in Duplicate) -- Date Issued ... --------------------- 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------_______ .-- �_ _ mac- t/ Owner's Noma - - � -- phone Address. ` z- __.---__`_�' Contractor's Name ......---•-----....2.. .� ?` ----------------•--•----------------------- -••---•---•- Phone-t `�F.YZ_r,✓ . Installation will serve: Residence 01. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of flying units: __/.___- Number of bedrooms __�_ Number of baths _I____ Lot size __.____ �r�-X_._� _d--__--__-..-_•---_____-. Water Supply: Public system JR""Community system ❑ Private ❑ Depth ro Water Table -------- ft. Character of soil to a depth of 3 feed Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ®' New Construction: Yes ❑ 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 Tanfi: Distance from neatest well---_-------------Distance from foundation-------.............Material_-_-___-____________-----------______---_-._.. ,e T`t-'�P No. of compartments--------------------------Size-------------••------ ••-------Liquid depth--------------------------Capacity------------- Disposal Field: Distance from nearest well---Ma_h.L Distance from foundation....lA_.._____.Distance to nearest lot line----J......... " Number of lines--------------/------------------Length of each line-------------1--------------Width of trench-------A-_-------------.-.._... - Type of filter material._._A04_--____Depth of filter material-----Lf----`_-._._=Total length_ :______6 a Seepage Pit: Distance to nearest well____16_h__C----Distance from foundation...... . .........Distance to nearest lot line__.........__. Number of pits-----__-_/-----------Lining materlal._._,of9r._e___4---Size: Diameter__--.�-,�-_ _____ Depth_----_2,!/--------------- Cesspool: Distance from nearest well _________________Distance from foundation-------------------.Lining material--------------- .--....--------------- �► ❑ Size: Diameter_____________________________---------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy- _ nearest well_ ______________________________________________Distance from nearest building riv❑ Distance to eaeIs� lot line Remodeling and/or repairing (describe):}� ---------------------•--------------------•----•----•--------•- -------------------------------•.........-------------------------------------------------------------•--•-------------------------- • ... -----------------------•-----••--------------------------- 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. Si ned L? 4_� �; - 5{ 9 }..--•-•••- --- ---..-._(Owner and/or Contractor) l By:.------ - '. .......... -------------------------------------------------------(Title}-.-------------------------------------------- ------------- (Plot plan. showing size of lot, location'of system in relation to wells, buildings, etc., can be placed on reverse side). +t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - . •- - - ----r<�'.�.._�----------------- •------------------------ DATE-.-•--�-�---------- REVIEWED BY---------------• I ------------------. DATE BUILDING PERMIT ISSUED.----••---------- I--------------------------------------------------------------------------------- DATE..- Alterations and/or recommendations:------------------ ------------------------------------------------------------------------- -------------------•-•--------------------- ---------------- ---------------------------•-------------------------------•-----------------------•------------------------------ --•---------------- FINAL INSPECTION BY:_.-_ __--_ _:.....: -------: Com- Date................................................ SAN JOAQUI LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS