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FOR OFFICE USE: :. ..------------------ --------------------------------- l..� APPLICATION FOR SANITATION PERMIT Permit No. ....) ' --------------------------------------------------------- (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 ADDRES?.. D LOCATION ------ G X.. �, _• � ._� t........... Owner's Name - -----------•- ----------------------------------- -----------------•-----••-----••----------•--- Phone...............•••••-••---•--- Address ----•-- /17/a. Contractor's Name -T w, Phone --•- ... Installation will serve: Residence PKApartfinent House E] Commercial L3 Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: ...I... Numberlof bedrooms __-Number of baths ...).-_ Lot size _.._ .. ....... - � s Water Supply: Public system ❑ Community system ❑ Privatej D< Depth to Water■Table .k_. ft. Character of soil to a depth of 3 feet: Sand [-] Gravel C] Sandy Loam ElClay Loam E] Clay ❑ Adobe X Hardpan ❑ Previous Application Made: (If yes,date-----_--------------)_ No New Construction: Yes)M1 No ❑ FHA/VA: Yes [3NOX TYPE OF INSTALLATION AND SPECIFICATIONS: i I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well,.�,}ti___..Distant from foundtion__. _! _______.M %ai________ ______________________________ No.1of compartments___ .,I_______________Size__-�.f,_�._.,�___Liquid depjh_..�_1��.......Capacity.I.J.��_.._ Dispo I Field: Distance from nearest well-A9-__-_Distance from foundation-----T--_��Distance to nearest lot ine.__�{' Number of lines_..._P----. _ Length of each line___(______-___•___-----width of french.___- ._._f�________________ `' t A.W.- Type of filter material. _� 4Depfh-of filter material.-14��_____._Total length..._._.__/__A41...................... Seepage Pit: Distance to nearest well----------------------Distance from foundation............. to nearest lot line................. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth------.._..-•---•-----•--------.. Cesspool: Distance from nearest well________________Distance from foundation__ --____.__-----Lining material______._.....----------.------------- El Size: Diameter------------------ -----------g 'De th--------------- --.-----_-----------_j-__ Liquid Capacity-----------------------------gals. --Distance from nearest well--------------------------------------------------Distance from nearest building ❑ Distance to nearesf lot fine------------••---------------------------------------•----•--•--------- -_-------- ----------------------------------------------- -.-- i ' Remodeling and/or repairin1 1 g(describe) - ` ---------- ............................................................... -------_-----------------................... -------------------------------------------------------------••-------- ---------------------• ---------••-----------------....._...----•----------------------------•------------------------------------- ---•---------• J .*. ---------------------------------------------------------------.......... -------------- -----------------------------------------------------------•---•------•---------•---------- •-•----•------- -•-•-----------------------------------------------------------------•---------------------------------------------•-•-----•---•---•-•---------------•----------------------------....----•------------------•----------. 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 regulations of the San Joaquin Local Health District. (Signed)A..� _ .i ------------------ -------- ----------------------------------------------- ----•-••------------(Owner and/or Contractor) BY:---- ..... ;------------•-------------•----;•-•--•--•- -- -------------------• :.-----------------------------(Title)---------------------------------------------- ----------------- (Plot plan, showing size. of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I ' - FOR DEPARTMENT USE ONLY [ APPLICATIONACCEPTED BY-------------------------------------------------------------------------------- ---------------- DATE-------•---•---•----------------------------------- -- REVIEWEDBY------------------------------------------------------------ DATE-------- fl ... BUILDING PERMIT ISSUED----------------------------------------- _ f Di4TE. Alterations and/or reca end'ations __._ ----------------- - ----------- ____ -------------------------------.....--•-•-•. -•---------- � _.. _ _ .._... ------------------------------------------------------------------------------ -•--•--•---------------- ---- ` ` - ---------------- ----------::::::::::::----:::--- ::::::-------- -:::------------ -- . - • FINAL INSPECTION BY:------ _------ Date------------- 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 EB 9 REVISED 8-59 2M 5-61 ATLAS - �� •mo-'