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FOR OFFICE USE: ------------------------------------=------------- Y? _ APPLICATION FOR SANITATION PERMIT Permit No. ... .. ... 1 ---------------------------- ----- Ci -------------- -- (Complete n 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. S49. JOB ADDRESS A LO AT ------------------ Owner's ��/_ " O—ura. ---�'` y'a/'---•-•-®.�-- .Jl _" ------------•-••-._. J � 4 Owner's Name----- -------- ---- - --• •-• .....�/' --------------- ---- - ---------------------------- Phone....----- ..--.-------------•-•- Address._ - --•---------------------------------------------------------•-•---------------- ----- .............•••••---- Contractor's Name-------- ------------- ----••----- ' Phone. Installation will serve: Resident Apartment House C-] CommercialE] Trailgr Court ❑ Motel ❑ Other ❑ Number of living units: .1----- Number of bedrooms__ Number of baths _1_.TLot size ------[ -�_ ..... ............... Water Supply: Public system [I Community system❑ Private Depth To Water Table/s - ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel F] San y Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan Previous Application Made: (If yes,date--------------------) No�,_ New Construction: Yes M\A ❑ FHA/VA�Ys ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) rbnrest"well_ ".&0' Dsean , from f-ound--aton____r._�Septic Tank: Dis#ance`f _.M ' Iquld depth a er�a. l r _ ___ --'------...Siz _... .ents--No. of compartm __.. ' Disposal Field: Distance from near t well_.. �istance from found t'on__ . .6--1___.Di tante to nearest lot line _____._.. Number of lines__`�_____y__ -____ ___._Length of each line n9W-_ WGPof trench____e . .___--------------- Type _fr------------- T e of filter materia d --Depth of filter material_13-14_ Total length_____,_.. ___-__________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line________.._.._... ❑ Number of pits----------------------Lining material-------------------.--.Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----------------_Lining material-_._-._-____-__-____._____...._..._-_ 4 ❑ Size: Diameter-------- ---------------------------Depth_--------------------------------------------------Liquid Capacity---------------------------- gals' Privy: Distance from nearest well __.______._____________________________-------Distance from nearest building---------------------------------..______- ❑ Distance to nearest lot line-----------•-----------------------r----------------,----------------------------------•--------•----.--------------------------------•------- Remodelingand/or repairing (describe):------------------------------------------------------------------------- --•-••---........-----•--•-•---•---....-•-----------•--•--••-••--------....•--- ------------•.......................•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----•-•---------------------- -•---------------------------------------------------------------------•------•--------------------------------------- I hereby certify that 1 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) q---.a----- b; .. ------------- ---- --------- ------------------------ --------(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). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------•------------------- •------ ----------------.----- DATE-----------.....---------- --------------------------------- REVIEWEDBY.-,--.---------------------------------------------------------- ---------------- DATE------ BUILDINGPERMIT ISSUED------------------------------------------- ;tee -------.----------- DATE-----.----------------- -- -----------------•------------- Alterations and/or recommendations------- ------------------ -----------------._..---------------------------------------------------------....-...------ --------------- ------•---------------------------------------------------- -- ------------------------------------------• ---------------•---•------------------------•- ---••----------------------------------------------- FINAL INSPECTION BY:_.----- 4_4 ate D -- --- .-..! ��'�- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California-_ a --Manteca,California Tracy,California E9 9 REVISED 8-59 2M 5.62 ATLAS }