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FOROFFICE USE: --------------------------------------------------------- --------------------------------------------------------- AWLICATION FOR SANITATION PERmvr Permit No. ... .�e/-�- --------------------------------------------------------- (Complete in Duplicate) Date Issued --- --------------------------------------------------- is Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per It to construct and inst II the work herein described. This application is made in compliance with County Ordinance No. 549. i JOB ADDRESS D LOCAT N g ---------��z--�h ----- S Owner's Name.. _-. u�r #-- ----------. Phone--------- Address--•-, - c Contractor's Name--------... •- --• --- . ---- - ---.. _ Phone----•-••-------•---- Installation will serve: Residence ❑ Apartmen ouse ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: _rj-- Number of bedrooms -------- Number of baths ._------ Lot size ..................1.._.A4..t..t_--Q_._:_......... Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay A 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 ank: Distance from nearest well--_-�O----Distancq from foyndati n__-_----- -.---.Mater�l.............. .. No. of compartments--------S-------------Size ___ _ �_X _�iquid depth.......V-----------------Capacity..?$_.__0.._0e� i Dispose Field: Distance from nearest well....XO----Distance from foundation--------------------Distance to nearest lot lin;�.5_.•_._.__. Number of lines---.._--_------------------ --- Length of each line....__..L-©-_0._._..__...Width of trench_---_Z. - 9 �, �-----•-------------- Type of fitter material...:!&! ---Depth of filter material___--- ---------Total length_-_---._- -- :�----------------- i f Seepage Pit: Distance to nearest well------I 1Q" ?--_--Distance from fo dation-•-----.--_..-..Distance to nearest lot line._----.- � [ Number of pits---------7�—------Lining material---✓i .Size: Diameter---- ----------Depth------Z-- ---------------- 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------------------------------------------ C�3 ❑ Distance to nearest lot line------------------------------------- -----------------------------------•-------------••---------------••---•----•------.-------- r r m Remodeling and/or repairing (describe):---------------- --------- 4-•� --------------------------- --------------•------------ -----------------•--....-----...------••------------•---•---------------------------•--------.-..-----••--•---•-••---•----•-------------•----•---------•---...----•---------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. (Signed). -"° -------------------- � {Owner and/or Contractor) �_ _ By:•----•• -�-•kt�� ---:_ __ ------.-Title -- ----------- v). (Plot plan, showing size of lot, location of system in rela n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---•--•------------------- --........___----------- DATE_ ---------- ..------------------ REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations---------------------------- ------- ---------•--•------------•--- ------------ -------------••----..------ ..----4--4- ---- --------------------�' --------------••---------. . -------•--L------------------------------------------------------- - --------------------------------- ------- ------------------------------- ---------------------------------------------------------------------------------------------------------------..---------------------------------- FINAL INSPECTION BY:.. ... 1�----------------------- Date---- -)Y_-.'7 -f----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lad[,California Manteca,California Tracy,California CS 9 REVISED 6-59 RM 5-61 ATLAS