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FOR OFFICE USE: r/'/ /��' ------ -- - ---------- ~--------- ✓___ __________ll � APPLICATION FOR SANITATION PERMIT Permit No. ....L` . .�.. - +------ ------------- --------------------------------- (Complete in Duplicate) -(a 1• ----- This Permit Expires 1 Year From Date Issued Date Issued ...................... Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No..549.`'- "C ' JOB ADDRESS AND LO A ION . 'a Owner's Name I .... e `" ------- = ----- ------ Phone............---------------------- Address...................................... Contractor's Name______.-fll_ - _ i Installation will serve: Residence � Apartmenf House ❑ Commercial"❑� Trape%r Court E]rMotel ❑ Other ❑ Number of living units: _/-____ Number of bedrooms-3_. Number of 1 size`_:_ .i - ____________________ baths Water Supply: Public system ❑ Community system ❑ •Private Depth To Water Table��__- ft. ti Character of soil to a depth of 3 fee'f: Sand ❑ Gravel ❑ Sand Loam Clay Loam, Cla Adobe ardpan ❑ I Previous Application Made: (If yes,date________________ :___) No New Construction: Yes o L];. FNA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) lr Septic T Distance from nearest well____ r I l ! p _____._Distance from foundafion._/v________}_.Material-- � __r"/.c_.�f--- No. of compartments-_�__Ar______.____size....,%_x-_yZ�__J•_Liquid depth__/&r__.---------Capacity....tlt-rte______ Disposal Field. Distance from nearest well---__�a- Distance from foundation..-.4__.___.1_.Distance to nearest lot line...... ..... ®� Number of lines_1______� 9______--___- __Len th of each line___ nr, I- ____.Width of trench___ _ ________________.... Type of filter material.�_� �,llQepth of filter material_ ..�.___!_______€._Total length_-------/...S------------____---- ______ l I / Seepage Distance to nearest well--- 1'_Q ______Distance from foundation__. .t------L.Distance to nearest lot line Number of pits__.___________--Lining material__ 1?_[�-} -----.Size: diameterl__, _3_.��-.----,Depth_..,;,S__.................. .__. .._.__. I Cesspool: Distance from nearest Well............. from_found1 ation________________:Lining material------------------------------------- ❑ `-- Size: Diameter 'Ddpth rLiquid Capacity...........................-gals. Privy: Distance from nearest well------------------------- _z--------------------Distance from nearest building.______--_-_____________------_......_.-.. ' ❑ Distance to nearest lot line----------------•_ . .. ---•---------------•-1____•----•- f Remodeling and/or repairing (describe)______________ i ` t { 1 ---- --- --•-------- --•-- - -- .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 and regulations of the San Joaquin Local Health District. I r -- _ ! q (Signed) ------ -- -- -------------------=------- ------- ---(Owner and/or Contractor BY� 3 ----- ----- =-' s = -----------(Tiifle)...... --- - --------------- - (Plot plan, showing size of lot, o ation of system in relation to wells,'buildt ,-_etc., can be placed on reverse side r. ( FO DEPARTMENT USE ONLY _ I APPLICATION ACCEPTED BY --------------------- DATE------- -- ----------------------------- REVIEWED BY---------------------------------------- `.` - -----""DATE--------•--•-- BUILDING PERMIT ISSUED---------------------- -••-•------------------- --- ------ DA �•-1-•--.:-_-•-- q�--- -- ------------------------- AFFerations and/or recommendations:. /0 I - 1 __ x ____________________________---------------------------- --------------_......_-------------------------------------_......................... ---------------------------------------------__----------------------------------_-------------------------------------_...--.___________.____-_-___-_--__•_._____________...---___:f1�--------------------------------........ ----------------------------------___..___-------------------------------------------------------------------------------------------------------.--------------------------------- -^..............................----------- E tl FINAL INSPECTION BY: �-----Y"`-.�`------------------•------- Date---___l'/_B' -`_`�_ .. s - SAN,JOAQUIN LOCAL-HEALTH DISTRICT 130 South American Street '300 Wed 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