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FOROFFICE USE: _ --------------------- __ ____________________ APPLICATION FOR SANITATION PERMIT Permit No. .�a�. ----------------------------- ----•-- ------------------- (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 complil ance with County Ordinance No. 549. JATHROP JOB ADDRESS AND LOCATION --------- -------- -- ------•---• -------------------••-- ......-. ........ . -•----......._ ---- Owner's Name.__` COCONVT` ItY Phone---------------------- •----------• Address. / _. .............----------------------------------------------------------------- ..... Contractor's Name------. Installation will serve: Residence(] Apartment ouse ❑ Commercial 5( Trailer Court ❑ Mot I Other ❑ Number of living units: -------- Number of bedrooms -------- Number o baths ., Lot s;z �� -------------- Water Supply: Public system ❑ Community system ❑ Private Number to Water Table( Z/_ 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 0 No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sDver is available within 200 feet.) Septi Tank: Distance from nearest well__._________ 1 stanc m founds fon___ ....Material '' . �_ � ...... .... No. of compartments________ ___--_...Size... _ i uid de t Capacity Q_ ,._ Dispo I Field: Distance from nearest-well....7�Distance from foundation--- J��........Distance to nearest lot line................. f Number of lines-______--/..... ........ . ..... Length of each line______ ___ Width of trench-__-I :: Type of filter material.l _/ Depth of filter material__ --- -------Total length-------�-5_______........____________ 6 Seepage Pit: `` Distance to nearest well_____-_-____-____-Distance from foundation-...................Distance to nearest lot line_............... 1j ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----.--.------------- Dept h_------------------_.--.- C' Cesspool: Distance from nearest well_____ ______r-_Distance from foundation--------------------Lining material--------..__._.____.._________------- y ❑ Size: Diameter--------------------------------___Depth----------------------------------------------------Liquid Capacity----------------------------gals. I ' Privy: Distance from nearest well_________________________________ mayfD-R�stance from nearest building------------------------------------------ ❑ Distance to nearest lot. line------------------------------------_ - A t x r ...........------------•------•-------•------•------------.----•------------------ Remodelingand/or repairing (describe):_--- --------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------- r --------------•---------•-•----------- -------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules e.rqd regulations-of the San Joaquin Local Health District. (Signed]- r --------------------------------------------------------------------------]Owner and/or Contractor] gr-------------------------------------------••-------------------------------------------------------------•---....................(rtle)-----------------41------------------------------------------ [Plot plan, showing sire of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. • � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- 1 1 -J -----------------------------------------•------------- ----------- DATE------�.�---- r -• --------- REVIEWEDBY------_------------------- -------------------------------------------------------------------•---•---•--------------------- DATE BUILDINGPERMIT ISSUED-----•-----------------------------------------------------------.....---•-------------------------- DATE------.-----•------ ----------------------- Alterations and/or recommendations:_.--__5+ _PT«_____TAN'_ -------tin[.5:rFt1--kJF--p___ '_ARPA. VZ1 ------___"T-i�._�__.....�'�"�i -----------------------------------------------------.-- ------------------------------------------------------...----------------------------------------------------------------------------------------------------- ----------------------------------------------•----- --- ------ FINAL INS -- - ------------------9___alewDate--------"V__.`/ --60-------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Slreat 124 Sycamore Street 205 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 7M 5-61 ATLAS