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-- w FOR OFFICE USE i --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. . ------------ ------------------r------- ----------- C-1 — _-_------------ -- [Complete in Duplicate) Date Issued --�..--� ••I This Permit Expires 1 Year From Date Issue - 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. d - v JOB ADDRESS AND L CATION------------- -�—c--�_-.-____..__ x.> -•--• -- ---- Owner's Name-------- !rV--?s ------- _ 7 _._!__.9 -------------------- -------- --------- Phone = Address �,�2.cr.x. rim ----------- Phone--------------------------------- Contractor's Name-------•-------------------- -- ------ ------- ----- --------•------ Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel [3 Other Number of living units- ------ Number of bedrooms -------- Number of baths ---------Lot size ----------- ----•••----- --------•-------•---•- �. stem ❑ Private E] Depth To Water.Table -------- ft. Water Supply: Public system 11CommunitY system 1. Character of soil to a depth of 3 feet: Scnd`E, Gravel [I Sandy Loam• Clay Loam ❑ Clay❑ Adobe❑ Hardpan Previous Application Made: (if yes,date--------------------) ..No�fl- New Construction: Yes1P No [jFHA/VA: Yes'[] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ��++ + - Material .f� �-...---•------ Septic Tank: Distance from nearest well ------------ ---Distance from foundation____-kf---- - ,. _Li'Liquid de th_-.----• -------•-Capacity--__- No. of compartments----• -' --------•-Size-.__��`.---• � S. q P. Disposal Field: Distance from nearest well-----------------Distance from foundation.-__-l3`__- Distance to nearest lot line...... ....... Length of each line___-____--3 _�-------------Width of french----------'"___-._..�___-. Number of lines ✓ g .Total len th--------------�' �----------••--•--- Type of filter material--------___ __-_-_-_Depth th of filter material. ....... --.--- g 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_.__-__ gals. Size: Diameter------- -------- ----------------• Depth th-------------------------------------------------- Liquid Capacity - ❑ • f ---------------Distance from nearest building Distance --------------- i. Privy: Distance from nearest we11-------------------------------- ❑ Remode�ing and/or repairing (describe):----------------------------to nearest lot ine_______________________ _ ------------------------- -----•---------------•----------------•----•------------- •----••---•--------------------------•------- ------------------- . ------------------------ ----•---•--------- --------- --•--_--•------------ -------- ----•-------------------- •b------- - --------I herr eby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an regulations of the an Joaquin Local Health District. -•----------------------- --•-------- -- =----(O r and/or Contract (Signed---• -'-4_-�-��--•- ---. -- `-�--- - ---- - -- wne d/o or) (rifle)-- VC- By: • - (Plot plan, showing size of lot, location of system in rel ion to we Is, buildings, etc., can be plated on reverse side). FOR DEPARTMENT USE ONLY u R BR --------- ,,JJ � �------------�o--- . DATE--------..�- -�-��-7----•-----------�------- APPLICATION ACCEPTED BY-------------------------------- DAT E---_----. ---- ------••-------------•-- REVIEWEDBY •--------•----------••--------------------------- ---------- ------------------------------------- BUILDING ------- --------------•--...�DATE.---------•------------•-----------------------------...----- BUILDING PERMIT ISSUED---------------------------------- ---------------------------------------------------------- ----------- _ AFterations and/or recommendations--------------- ----- ---- ---- --------- ---- --•---'----'- ---__.-----••----•---••----••--•---•-----•----------- ------------- --•------------------- / - ` ------------- -- ------------- z� FINAL INSPECTION BY:............... . ...�-�- -- - -------- ---- Date--- -------- , VIC—SA JOAQIJIN LOCAL HEALTH DISTRICT 300 West Oak Serest 124 Sycamore Street 405 Weft 91h Street ,u 130 South American Street Tracy,California Stockton,California Lodi,California Manteca,California ES 9 REVISED 8-59 21A S-62 ATLAS