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rVKvrrK-t LJ,')k: ; ---------------------------- -- ----------- ----------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. .._ 1..t�' - --- -------------------------------------------------- (Complete in Duplicate) --- ------------------ This Permit Expires T 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 CATION -= '" ter° � -- (0 l 7— 0�,o 3�y Owners Name.---- --- /� ADDRESS AND LO- �----- �� • �' ---•-"---------------------------- -------------------------------------------------- Phone.. Address.................. -.rte•"" .._ •' .- -•---•-----------------------•"-- Contractor's Name.... . _--,________•••__----------------------------------- ---- ••-•-----. Phone..----------- Installation will serve: Residence [] Apartment House ❑ CommerciailA Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths A__ Lot size ---/.jP,..'!hp5!--,_._____- ...---_...._...-.-•.----•••-•- Wafer Supply: Public system ❑ Community system [3 Privatea] Depth To Water Tabled ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: llf yes,date--------------------} No ] New Construction. Yes_] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___2;F Distancllfroom foundation_-�0-----------Materiai_49>2 Ok No. of compartments-----�'---------------- Size- : .1 S ---Liquid clepth__#-------------------Capacity./Z OT Disposal Field: Distance from nearest well...' m"---- Distance from foundation__At_'-.........Distance to nearest lot line..!"-"" IBJ Number of lines.._-__-l---- ----------------- Length of each line �-�------------ Width of trench of filter mate ri� ,p •-- ' -------"--••• rpt _-Depth of filter mafierial___� --------------Tota! length--- d-- ---------*-------------- E Seepage Pit: Distance to nearest well---------.------------Distance from foundation........_-----------Distance to nearest lot line------- a El Number of pits--------- ------------Lining material---------•-------------Size: Diameter-----------------------Dept h--------------..._- ---..._ n0 _ n Cesspool: Distance from nearest well---------------"_Distance from foundation....---------------.Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth_-------------------------------------------------Liquid Capacity., Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building (] Distance to nearest lot line--__----_._-----.-_--._ Remodeling and/or repairing (describe):-__-__- --------------- ----•----•---•----•--•------------------------------ ----------I---------------------------------------------------•---"---------•--------•---•---------------------•----------------------------••-----•--------•-------------•-•--------•----• ------•-------- -------------- --------------"------•------ --------"----- --------- - - I hereby certify that ( have prepared this ap ' ion and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, a rules and lotion of the Joaquin Local Health District. (Signed)_- - -_ (Owner end/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 APPLICATION ACCEPTED BY_---- --------- REVIEWED BY ----------------------- DATE.. - /a_'ef,?�-.".------------- ------- ----- -------------- DATE----------- ------------------------------------------------ Alterations ---------- - BUILDING PERMITISSUED-,------------------------------ -• -------------•-------- DATE-------•----- ----------- A erations and/or recommendations--------------------- -- --- ""-----•------ -----------••--- ---------- --- ------------y.--- FINAL INSPECTION BY------ ---------- ---------------------- •--• --- - ----- Date----/x/6.4" - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sthet 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 9-62 ATLAS