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p 1-UROFFICE USE: ` gs-0 � -.--- '--`7 APPLICATION FOR SANITATION PERMIT Permit No. .� -------------------------------------------------------1-- (Complete in Dtipj licatej, --------------------------------------------- ----------- This Permit Expires i Year From Date Issued 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. r'- JOB ADDRESS AND LOC TION Owner's Name--------- ... . -P� ��c-f s. z c-r Address..___...- .-- �z ' � -c -s ------ Phone.-•----•------•------------•------.• �� 1/ -•-•--•----•-•-•--......•...... �--•-----••;•---•--- Vit;,=------------- Contractor's Nam.____ ------ ---- Phone................-----------------• Installation will serve: Residence B"-A-partment House ❑ CommercialTrailer Court ❑ ❑ Motel ❑ Other ❑ f, Number of living units: _/.___ Number of bedroomsy ___ Number of baths Y__ Lot size _... 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 [-IAdobe C] Hardpan C:1Previous Application Made: (if yes,date------_......_-------) No New Construction: Yes k2 1Vo ❑ FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well--.Y— -----Distance from foundati n___ n__ _ Material ��++ No. of compartments--------- -__----Size---G�1>--- -- -�? Liquid depthT____ / Lapac�ty./— ----- Disposal Id: Distance from nearest well_�C._Distance from foundation.__-.._ .._.Distance to nearest lot line_-tC ... Number of lines------------------ Length of each line______ ___ __ g I/ Width of trench.---- j t Type of filter material..._ --------- length.______.,L',___...L Seepage Pit: Distance to nearest well r49-0------Distance fro fou dation____Z-52•-____.Distance nearest lot line ; Number of Pits--------Z�------Lining material____ n C-f�$ize: Diameter___ - Depth__ -.- --�-- N. 7 Cesspool: Distance from nearest we!!_________________Distance from foundation__._______._..- _.Linin material-.._____._____________--. ❑ Size: Diameter----------------------- Depth Liquid Capacity gals. �~ Privy: Distance from nearest well__-_ ______________________.___._--_-----Distance from nearest buildin ❑ Distance to nearest lot line ---------- ------------------------ •.....-----•-•-----------•-------•-----------------------•-- f� r��l Remodeling and/or re airing (describe):__-e - _ v -=�----------------- I 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 ulations of the San Joaquin Local Health District. (Signed)><-- V ----------------------------------(Owner and/or Contractor) --Ill--{-- ---------------- ---------------------- - •-- ay:_----------------------_----------------------------------------•- ----------------------------------- - - - - ------ Title (Piot 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 t - -•----------------------- DATE..--r..�, ,/ �(`1 REVIEWEDBY ------•----------------------------------------------- ------------------------------------•----•--------•-- DATE---•------------------ ----------------•- UILDING-PERMIT ISSUED-------------------------------------------------------------- --------------------------------- DATE- Alferafions and/or recommendations_____________________ --------•----------------------•----••----•---••-------------•----...-----•----------•-----------------.----- -------------•------------------...----•-----------•------ •.... -- -------•-----------------------------------------------•-----------•------•----•------------- y--------------- FINAL INSPECTION BY:-__..._. •- - _ CZ Date ,Z-------------- AN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 00 Wast Oak Street 124 Sycamore Street 205 West 9th Street + Stockton,California Lodi,California Manteca,Collfornla Tracy,California + ES 9 REVISED 8-59 2M 5.62 ATLAS f