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ra FOR OFFICE USE ------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .....�5� � -------------------------------------------------------- (Complete in Duplicate) X1 � -- _________________------------------------------------- This Permit Expires 1 Year From Date Issued ' 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 ADDRESS A L CAO `�-/I....X... ... --------------••-----..-.._._. Owner's Name ---------------------------•------------------------------------------------------- -------------------------------------------- Phone.................................... Address----------- ` -l�`� �--�- Contractor's Name--------- ---------------------------------------------------------------------------------------- ------------------- Phone............................------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J___ Number of bedrooms-___Number of baths ---I--- Lot size _*7. 57.X_7 ___________ -------------------- Water Supply: Public system [I-~Community system ❑ Private ❑ Depth ro Water Table .400_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe�'Rardpan C1Previous Application Made: (If yes,date--------------------) No K, New Construction: Yes �o ❑ FHA/VA: Yes [] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Septic __________________------ ---.Liquid d;pth---•�- ---------------.Capacity Distance from nearest we (_Distance from foundation_14------------Material-___-_/-_`" - ---___-.-_--•--•__ __------ ______ No. of compartmentsy ._Size..---.��-��-x-�-- -- Pact �-1J•-��-� Disposal Field: Distance from nearest well-_'-�__._Distance from foundation.1L)____---------Distance to nearest lot line__........ Number of lines_.....--:e--- -- ------- -----Length of each line------_46_ _.________..Width of trench.___.Af..f.------• ----.-- c c� 4e Type of filter material__._._/____4'K____.__Depth of filter material___-/$_._____ --..Total length_______�/--o........................... If Seepage Pit: Distance to nearest well--r-----___-.Distance�� foundation__..L�....______.Distance to nearest lot line_...5�____ 1Y Number of rts--_-_____ Linin material._.__1_CoC�--.Size: Diameter__s _�_______Depth__.._____- 2cF`�__________ cam p I---- g Cesspool: Distance from nearest well-----------------Distance from foundation---.------e--------.Lining material-____-___-_-______________________ ❑ Size: Diameter--------------------------------------Depth------------------------------------------:----------Liquid Capacity----------_................gals. Privy: Distance from nearest well-----___-----------------------------------------Distance from nearest building------------------------------------------ 0 Distance to nearest lot line--------------------------------------------------------•------•------ ---------------------------------------------------------------------- Remodeling and/or repairing {describe)------------------------------------------------------------------------------------------------------------------------------------•----•--•------------ r •-------------------------------------- -------------------•---•-.------•--.--------------------------------•-.-------.---.....-.--•-•--------------•------------------------------------------------------------------------- ------------------------------------------------------------ •-------------------------------------------- ----------------------------------------------..--------------------------------------------------:---------•----- hereby certify that I have prepared this applicatiou and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations th an Joaquin Local Health District. (Signed)------------------------------------------------------------------- --- ------------ - -------------------------------------------------.------------------(Owner and/or Contractor) By:---------------------------------------------- -------- ---- -- -------------- -----------------------------------------------(Title)----------- -------------------------------- ---------..-------- (Plot plan, showing size of lot, location system in relati to wells, buildings, etc., can be placed on reverse side). FOR 6EPARTMENT USE ONLY APPLICATION ACCEPTED BY---- `s DATE--- '---------------------------- REVIEWED BY----------------------------------------- ------------------------------------ ------------ - --- DATE-------------------•----------------- ------------------------ •- ---------._....------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations---------------------------------------------------------------.----------•---------------------------------....-.........--•--•-----•-•--•------------••------ ---------------------------------•------------------•--------- ---------------------------------------------------------------•------------------- -------•- •----------------------•-------.-------------------------------- ------ ------------------------------------- ---------•-------------- -------------------------•-------------- ---------•---------------------------------------•------------------...-------•----------------------------------- FINAL INSPECTION BY:---0--=- `"" 'ss Date-----1--_.5 ...(PZ'------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sneet 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62! ATLAS