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FOR OFFICE USE: --------------------------------------------------------- - -- --------- ------------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. zzzlet/_/14. ------------------------------------------------------ ficomplete in Duplicate) ------------------ ------------------------ -------- This Permit Expires 1 Year From Date Issued Date Issued d 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 49. UZ JOB ADDRESS AND,40CATIO /A - --- --- Owner's Name_. �V~ - ------------ -------- ------- --- -------------------�/-•---- Phone. ------ Address............ Contractor's Name... Phone-- 41i7i " Installation will serve: Residence Apart ent House E] Commercial - -- ------------------------------------ -4 lV C] Trailer Court [3 Motel [I Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ---/_ Lot size Water Supply: Public system 4 Community system F1 Private E] Depth TO Water Table -------- ft. Character of soil to a depth of 3 feet.- Sand [-] Gravel [-] Sandy Loam k Clay Loam ❑ Clay [I Adobe[] Hardpan ❑ Previous Application Made: (If yes,date-----:I---------------) No ORr New Construction:- Yes 0 No [4 FHA/VA: Yes [_ N0 TYPE OF INSTALLATION AND SPECIFICA ft 0" N S: (No.septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tgn :,, 0% - Distance from nearest well_____-__________Distance from foundation___________ ______Material,---------- o. of compartments------------------------- ---------*----------------**---------- Size--------------------------------Liquid clep�h--------------------------Capacity----------------------- Disposal Field: Distance from nea'r s wel Distance from foundation Distance to nearest lot line._______. ..... of trench----- F-1 Number of linesJ. -d ngth of each line------X� ------ Type of filter material--------- ---------------Depth of filter material--------_--------_---Total length"--------------__-----. •--------•--------- Se ength------------------------------------------ Se e Pit: Distance to nearest well--A�_ - -----Distancedrom f clati "Tu In ... ion .0........Distanc�e to nearest lot line_. --------- Number of pits......../------------Lining material-,4W.. ize: Dia meter--.Zyd". .Depth-_-2-, - 4F 5................. Cesspool: Distance from nearest well-----------------Distance from foundation------------------".Lining material_..-----___.________. ------------- E31 Size: Diameter.-------------------------------------Depth---------I -------------------------"Liquid Capacity---------------------------gals. Privy: Distance from nearest well - --------------------------------- -------Distance from nearest building------------------------------------------ r ,�, wel Di ❑ 4:......... D Distance to nearest lot line Remodelingand/or repairing (describe):---------------------- ------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------- --------------------------------------------I-------------------------I------------------------------------------------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I--------------------- ------------------------------------- --------------------------------------------I------------------------_----------------------I-------------------------------------------------------------------------------------- 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)--------------------------- ------ ------------- ---�!�--------------------------------------------------- --------------(Owr* and/or dWtr'aI -------------- ------------------------------------- Bye..... o-/ (Plot plan, showing size of lo I c. on of system in relatiori011fw'ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - -- REVIEWED BY ----_-------- - . :......----- -------------------------- DATE -----7- ------------ ------------ BUILDING PERMIT ISSUED--------------------------------------------- -------------�___ "-------------- DATE Alterations and/or recommendations------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------- --------------------------------------------•--------..".------------•--- -m------ ---------- --------------------------------------- -------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- ------------------------------ -------------------------------------------------------I-------------------- -------------------------------- --------------- ------------------ -------------------------------------- - -------------------------- ------------ -------------------------------- --------------------------------------------------------.. ...... FINAL INSPECTION BY:- - - ---- ---------- --------- Date--------F� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wool Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California TraCYr Ca"11forniIa Es 9 REVISED 8-59 21A 5-62 ATLAS