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I-UK Ufl-K-t USE: - ------------------------ -------------------------- /.. -----------------------------------------------------___- APPLICATION FOR SANITATION PERMIT Permit No. . . ...�1_/.� --------------------------------------------------- (Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued Date Issued ..__.------ - . 6_`L Application is hereby made to the San Joaquin Local Health District for a permit to construct and install to work herein des ribed.. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN LCATION_._ + -••-•------- ----------------------------- Owner's Name------ . ...... -- •--•--------• e - ------� - -----------------•- Phone.................................... Ir --- Address---------------- 1.. .. 04-�- -------- Contractor's Name._____•------_-- -- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms -------- Number of baths ........ Lot size _________________________.......................... Wafer Supply: Public system ❑ Community system ❑ Private Depth To Water Table --7 ft. 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 ❑ 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: 76i stance from nearest well=___._-'"^_ _Distare from fndation__ _ ..-----------Material __. ...__.. Ap L ` ZC�.�' No. of compartments ----------------Size---- x1��--------Liquid depth--..-.4-------------•--Capacity --•- Disposal ield: Distance from nearest well_________________Distance from foundation..... Distance to nearest lot li e_._____..._....._ CN (J��el. Number of lines------------ Len th of each line_-. 7 9 ," L1 Width of trench l 13..ej( Type of filter material._..... d-4 -----Depth of filter material .___ -------Total length....... °•---------------------- 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----------.____-___-______----..____ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------- Distance to nearest lot line-- ---------••-------------------------------------•------------------ = Remodeling and/or repairing (describe)------- ----------------------------------------------------------_--•-----•- -•--------•---------•--•---------•------•-------------•--------------------------------------•--------•------------------------••------•------•-----------------------•-----••-----•----•-•---•------------------------ 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) " g ) - ----- ----- {Owner and/or Contractor) 1 BY� -•----•----------------------------------= --------------•-- -------•--------- -----------(Title)----- -----------''-' -- - ------ =--- -- ----- (Plot plan, showing size of lot, location of system in relation to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------C -- - ---- ----------------------------------------- DATE ---------•------------------------•-----....---------- REVIEWED BY-------•----------------------------------------- -----------------------------------------------------•------------------- DATE------------------_------- -------------------------------- BUILDING PERMIT ISSUED------------------------------------- ------•---------------------------------------•--•------------- DATE--------------------- Alterations and/or recommendations_____________________ _ FINAL INSPECTION BY:. ---- - - - .; . -- •---------------- Date-- !' �b ------------ ............... ----------- ---•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Arrierican Street 300 west Oak Street 124 Sycamore Street 205 Wear 91h Street Stockton,California . Lodi,California Manteca,California Tracy,California E5 9 RIEVISED B-59 2M 5-52 ATLAS