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FOR OFFICE USE: -------- ---------------- ---- ------------------ -------------.-- ------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. - - ------------------------ -------------------- (Complete in Duplicate) ---------------- --------------- C'�',.... ----------- ----- --- This Permit Expires i 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 CATI __- -_ j�l Owner's Name-------- , ------- - -- ------ Phone............-------------------- Address-----...----`/J,?.t .... r Contractor's Name-------- ,1119V9 ........ Phone_._. --. Installation will serve: Residence �Aparfinent House E] Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of livingunits: _/-_-_ Number of bedrooms ~� �-- Number of baths -.�-_ Lot size --��_-�-`�------------------------------•------ Water Supply: Public system [G'Community system ❑ Private ❑ Depth To Water Table _454. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-------------_-----) No [E '�'New Construction: Yes Er"'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 we L..C,�G�----_Distance from foundation �- -- _ d� fZ ............... ......... ( No. of compartments---ox------------_---Size-.!r ,F_- x- h��-_Liquid depth--_` .. Capacity Disposal Field: Distance from nearest well__4P------Distance from foundation---1A---_-.-- Distance to nearest lot line_= .�...... Number of lines-------- ------ Length of each line.---_- !_----. Width of trench__. Type of filter material-/ -- _ / pC------Depth of filter material---/_ �`_- -Total length--_ _- _ .-_ _-, ` or 5eepag It: Distance to nearest well--- p49�-._-Distance from foundation_...e� __._...Distance to nearest lot line_--��--_.. Number of pits----- -------_-----Lining material-- --_Size: Diameter---- �� ------.:Depth-,�->��-.._..------•---- {.� Cesspool: Distance from nearest well-----------------Distance-from foundation-------------------.Lining material_----------------- �y ❑ Size: Diameter------------------------- --------Depth-------------------------------------------•--------Liquid Capacity-------------------------_- Privy: Distance from nearest well-------------------------------------------- -Distance from nearest building ❑ Distance to nearest lot line Remodeling -and/or rep •ring (describe)-------- -- 1 . � ----------------------------------------------•------------------------- -------------------------------------------=•----------------------- ----------•--- I hereby certify that I 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)-------------------- -----------�¢or Contractor By:----------------------------------------------------- -- -- - - ----------•----(rifle)---- 1-`- (Plot plan, showing size of lot, location o ystem in relation to wells,.buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------------------------ T 7-- �_� ATE-------- -�REVIEWED BY--.. - -_ DATE ----Z------- --- - - - --UILDING PERMIT ISSUED-----------••-----------------•----- ----------- Di4TE------••-•-----------• -•- ----------------------------------- A erations and/or recommendations:-_----------------------------- . --------------------------------- -- --•-••---------------•----•-------------------- •---------- � -------•-----•------------------------ -------•-----••----....----•----•------------------------------------------- ------- -•----------------------------------------------------------------- --------------------------- --------------------------- FINAL INSPECTION BY:--�`--._ f T- - -- --- -------- ----- -------- --------- Date---- �— 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 8-59 2M 5-62 ATLAS