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r FOR OFFICE USE: ,. --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- . _-..-•--• (Complete in Duplicate) �- -----------------------___ .__-----------.-___._-_._-. This Permit Expires 1 Year From Date Issued I 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. JOBADDRESS AND LOCATION------ :_Q..!:-.�C�`-�--- ••--- --- --- ---1'24-& JOB Owner's Name -----••--•••- ---------- .............. ..� - Phone. Address. . -1-6----------------------------------•--- -----••- ----___------- -----•-•--------••. -------------- ---- ne- Contractor's will : Resid Apartment House Commercial Trailer Court ❑ Motel o❑ �fherInstallation w fl se e ❑ p ❑ ❑ a Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size ______ ___-_ ------- Water Supply: Public system ❑ Community system ❑ Private h< Depth To Water Table _______ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [g Clay Loam 0 Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No191 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{ Tank: Distance from nearest welI_?_& O. Alaye from foundation......�6------- ML�- --- ---•---•-CityNo. of compartments----Y----------------Size___-x.�_.X_-Z Liquid deph------'___- apac Disp al Field: Distance from nearest well-A00-0- from foundation____ ?r Distance to nearest lot line- .-.- Number of lines___1----------------------------Length of each line_____.?__ y.�_____-Width of trench___ Type of filter materiaL5'� _Depth of filter material-__1��5__------------Total length__ Seepage Pit: Distance to nearest well------_---------------Distance from foundation_.__-___________.Distance to nearest lot line-----------_--- El Number of pits-----------•----------Lining material-----------------------Size: Diameter----_------------------Depth----.•-•------------------------- Cesspool: Distance from ,nearest well-----------------Distance from foundation------------------- Lining,material____--________--.-___________________ Size: Diameter-------------------- ------- --------------------Liquid Capacity------ ----Y_------•-•gals. ❑ Depth - Privy: Distance from nearest well________________________________________ -------Distance from nearest building-____-_______--_______________-.---------. ❑ Distance to nearest lot line----------------------------- ----------------------------------•----------------------------------------------------------------------------- Remodelingand/or repairing (describe):---------------------------------- -------•-•---•---------------------------•----••••-•----------------------------•---•--••----------••--------------- -------------•------------------•---------------------------•-- --• ••-----------------------•---------- ------•-------------------------------------------------------------------------------I---------------------- 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 red regulations of the San Joaquin Local Health District. Mi (Signed) ---------------- ..... - ------- --- ----- -------------------- Owner and/or Co tractor) .- By----------------•--•---•-- ------------------------------------------- (Title)_._. - . �'' --- -.------- ----------- (Plot plan, showing size of lot, Iota ion of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------•------------------------------------ -----•------------------------ DATE-------- -•-------•------ `- ------------------------- REVIEWED .BY--•-------------------- -------•- ---•--- ------------------- -••--•-•---------------- DATE_- ----.1-�---`--------------------------- BUILDINGPERMIT ISSUED-----------------•-------------------------------- -------------•------------ DATE-_---------- ---- ------------------------------------------- -A--l-t-e---r-a--t-i-o--n--s -- --------------------------------------.--•- Alterationsand/or--r-e--c--o--m---m---e--n--d--a--t--i-o--n--s-----------------------------------• ---- •-----------•-••--------•--•--•---------••------------------••----___-•-•-----------------------•--- FINAL INSPECTION BY---------- ---------------------------------- ----- ---- Date------- ---- r 7------- ---------------------------- SAN JOAQUIN'LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS ,,.•�