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FOR OFFICE USE: --------------------------- ----------------------------- / _______________________________________._______._ APPLICATION FOR SANITATION PERMIT Permit No. ----------------------- -- -------------------------- (Complete in Duplicate) f -�-"---------------- ----�-----��--�----------------- 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 AND CATION---- _C_�- '"----- - -� Owner's Name -•-------------------------------------------------------------j__--- Phone.--_... --------------------------- Address _... .......-- Contractor's Name--------- �.. __.---••-•--•-•- -------- ----�---------------------_ Phone.............---------------------- --- -------- -- Installation will serve: Residence Ix Apartment House ❑ Commercial ❑ Trail �er�Court [:] Motel El Other ❑ Number of living units: --- Number of bedrooms ---1q. Number of baths �__!Y- Lot size .....7ss __l A0............................... Water Supply: Public system ❑ Community system ❑ Private epth To Water Table -14)_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ElPrevious Application Made: (If yes,date--------------------) No N [- New Construction: Yes 1q_.[] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicsewer is available within 200 feet.) Sep 7T�n : Distance from nearest well _- 'Distan a fr m foundation__:__ '. M-�tof ial-:'--�- --- p +y- -� � No. of compartments_______---_--_._Size__ ___, __ _�r_._Llquid depth___` `' _ Ca aci I__ _C�...... ��--^^ Disposal Field: Distance from nearest well--- 1-- .....Distance from fpundati,o -Z?-0. Js a racs_10 nearest lot line....,... [ Number of lines........ _ Length of each lirie�__..��=_ . h`o � f french_______ �.4�-« Type of filter material17ilidt , . --Depth of filter material___/9_____________Total length____,,.--- ..._....__...__ Seepage Pit: Distance to nearest well------------_---------Distance from foundation....................Distance to nearest lot line......-_.._.-____ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth__--------------------------- `34 s Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____--.____.______.___________-_---_ r ❑ Size: Diameter--------------------------------------De th----------------------------------------•----------_Liquid Capacity p ----------------------------gals. Privy: Distance from nearest well------------------------------------.-------------Distance from nearest building------------------------------------------ n Distance to nearest lot line----------------------------------------------- -----------------•-•-- Remodeling and/or repairing (describe)------------- ---------• ----------•--------------------------------••------------------------ r I hereby IrlatIhave preparedthis application and:that the work will be done in accordance with San Joaquin County ordinances, St and rules and reg ons of the San Joaquin Local Health District. (Signed} A= - --------- - - - -----------------------------------------------------------------(Owner and/or Contractor) By:_------------------------------------------------------------------------------------------------------------------------------(Title)------------------------------ -------------------------------- (Plot ------- ----- -- ------------- (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------------------------------------- REVIEWED ------------------------- ...REVIEWED BY---------------------------------- ---------------------------------------------------------- DATE..... _ • BUILDING PERMIT ISSUED.-------•--- -- -------- DATE--------------_---- .._ ` �� Alterations and/or recommendations------------------------------- w ---------------------------------- ----------.........•--------------------------------•----------------------------------------------- ---------------- ------------------------•-------•-•-------------------- -------•----------------------------------- ----------------------------- -------- ------ ---------•---•------------- ------ -----------------------------•--•----------------------------•---•---•---------------------•--------••----------------•-----•--------------•- FINAL INSPECTION BY:------ - . ._ ---- ----------------- Date.................... ...,ky �------ 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 5-59 2M 5-52 ATLAS