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FOR OFFICE US : _ �p ---.- r /� -------------------- __-__-- ,-r -(r_�,_-- / -APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) � . -_______________ 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 LOCATION•-------�_�'-- ---•---- --- ----------------------•------•------------------------------------------------------------------- -- --------- Owner's Name-----�✓1...... �J� •--- --------------- •-------------------------------••- ------ Phone.................................... Address-----------1Z._ u �' -------------------------------------•-------------------•----------------•-••---•---- Contractor's Name ___T 7s---•---•--------------•-------------------------•----------------•--------._....- Phone................................... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ J i Number of living units: ..__ Number of bedrooms _. __ Number of baths __. __ Lot size _. A_A-I__10............................. ------------ Water Supply: Public system 60mmunity system ❑ Private ❑ Depth To Water Table __�o ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Eh—New Construction: Yes 51,41o-_0 FHA/VA: Yes ❑ No E–g.� TYPE OF INSTALLATION AND SPECIFICATIONS: [� t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) J Septi nk: Distance from nearest well_________________Distance from foundation--------------------Material________-.--_--____________--------__.__________- lo. of compartments------------- ------Size----_----------------•----_---Liquid depth--------------------------Capacity----------------------- Dis Distance from nearest well_-Distance from foundation----i---------------Distance to nearest lot line................. Number of lines.......................__________Length of each line_-_: Width of trench____ ----______.__.._...- Type of filter materia._. -f___ . Depth of filter material__ _ Total length-------- .U________________________ _ J Seepage Pit: Distance to nearest ell_.�1 _____Distap�rom foundation-_.5_A..-..___Distance to nearest lot line__-- -_-___-. Number of pits---- .. 9 /�Vj Size: Diameter---- Depth----------"- .--�5��------ / _______Linin material___ _ _ ----- Cesspool: Distance from nearest well----------------_Distance from foundation-------------------.Lining material-------------------------------------- El 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):--------------------------------------------------.--------------------------------------------------------------------------------•--_---------..---- --------------•----..-.------------------------•------------------------ •----•---•----------------------------------------------•-----------•---------------------------------------..-------------------------------------- -------------------------------------------------------------------------------------------------------------------------••-•-------------------------------•-----•-•-------------------------------- •q----------- y I hereby certify that I have prepareX� m ation and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and rethe Sa Joaquin Local Health District. (Signed}... - -- (Owner and/or Contractor] Sy:------------------------------------------•. --- ------------------------------------------..-..--------(Title)-------------------------------- •--- -------- --- ---------(Plot plan, showing size of lot ron oation to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY----------- -- —_- ---------------------- DATE--------- f Z ------------- REVIEWEDBY------------------------------ - ---------- ----------------------------------------------------------------------------- DATE------------------------------------------------------------ -PERMIT ISSUED--- ----•--- DATE-------------------•---_--------------_--- -------- --- ------ Alterations and/or recommendations:-_-____ .-1__7.._ ---.--./--� ___ = -_ ----`-----� � 6 • , I ---------------- - ----------- ------- •------- - --------------------------------------------------------------------------•--------------------------•----------------•--•----------------- FINAL INSPECTION BY: - -------- 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