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FOR OFFICE USE: _________________________________R____________----_ ? f/X APPLICATION FOR SANITATION PERMIT Permit No. 51.••"1..... --------------------------------------------------------- (Complete in Duplicate) Date Issued ------------- ---------------___------ ----------------_. This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo rein scribed. This application is made in c pliance with Coun Ordinance N . 549. JOB ADDRESS ND LOCATI N- _----------------------- ------ = r ..- - . -• . -----•---•--------------••-• ------------ ------------- Phone----•---_----•----------------•-- Owner's Name l Address-....... - ---------------------------------•----------------------------------------------------------------._................................................................. I Contractor's Name--------------• •• --------------------•---------------- Phone--------................. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----!-- Number of bedrooms 3__. Number of baths 4Z, Lot size .....--�3`'-T'S ----------------- } Water Supply: Public system ❑ Community system ❑ Private Ej Depth To Water Table _20- ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[!rHardpan ❑ Previous Application Made: (If yes,date---_-------_--------I No�r New Construction: Yes ZNoU FHA/VA: Yes eNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r �� Distance from foundation__-_ Q___._...__Materiae Septic Tank: Distance from nearest well________________ ! I [f No. of compartments_.__Z--------------Size---�1' 5` j4----- ---Liquid depth---__Ki.--------------._Capacity--.�?ot' uJ1 Dispos Field: Distance from nearest well--------Distance from foundation_®---------_....Distance to nearest lot lines'_.___..__ i Number of lines--------`L --------Length of each line-__7�--------------------Width of trench-__.5;-- ---------..-._--•_-- Type of filter materiaf` _c1f_k_____--__Depth of filter mate rial._�gi"_�`_-_________Total length_:___/�:2 -..`______________________ b -- Distance to nearest SeepacSe�Pit: Distance to nearest well__/l�------------Distancem foundation---l_.__-.-_•__...�� ` � � -Linin material__'___ 0CA.__-_Size: Diameter________________...___Depth_-____�______-_--___------ Number of pits_____ ___ ________ g 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_--____________-_________- ------------- ❑ Distance to nearest lot line------------------------- ----------------------•------------------------•-----•------------------------•------------•---------------------- --------------•-•---------•-••-----------•-----------------------.--------•----------------------------------------------• V' Remodeling and/or repairing (describe}______________________________ _ r'^ ---- ----------------------------•----------------------------•------------------------------------------------•-•-•----------------------•------ 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 reg i ns�f the San Joaquin Local Health District. (Signed)------------------------------------------------------ ---- -------- ------------ -----------------------------------------------------••- ------------(Owner and/or Contractor) BY: -• -----------------------------------(Title)---••-------------------------- -------- -------------- [Plot plan, showing size of to , ovation of system in'relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY IF APPLICATION ACCEPTED BY------ --- - ------- -- --------------------•---------------- DATE----- - ------- REVIEWEDBY-------------------------------•------------- - ------------ ----------------------------------------------.....----------- DATE.----- •---------------------------•---•-------------------- BUILDINGPERMIT ISSUED................ —--------------------------- ----------- DATE------------------------------------------------------------- Alterations and/or recommendations -•-•--------------•-----------•-------------------•----------------------------I------------•--------------------•---------•--- --------------------------------------------------..---------------------------------------- ------------••-------------------------•------------------------------------ ---•--------------------- --------....------------•-------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------•---------------------•---•----------•--------•------------- -•-----------•---•--------------- F • ----•------•-------------• •--------------------•--------------------- ---------------------4-------------------------------------------------------------------------I----------------------- - ------------------- FINAL ---------- --------FINAL INSPECTION - _ -- --- -- Date--/ . 1 ------------------------------------ 1I SA AQUI LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 dM 5-62 ATLAS r't!