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FUR'UFFICE U5E: -- ---------- ------------------------ _1...... ------- APPLICATION FOR SANITATION PERMIT Permit No. ___,l S-._, z --------------------------------------------------------- (Complete in Duplicate) Date Issued ----------- --------------------------------------- This Permit Expires 1 Year From 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. 2P9-(_ yL JOB ADDRESS AND OCATION___ - --------`--��' Owner's Name -- rr _-------- J �- - ----- -� ------_---•-----------_------------------ Phone.................................... Address....................... i_...- ►e. �- Contractor's Name- ` Phone �- ----- Installation will serve: Residence [g'*--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ On Number of living units: ...I_ Number of bedrooms'____ Number of baths _f----- Lot size __W.0__X....sax---l-__1_tx,11........ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth To Water Table.-�``___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes date.__--__.___._____) No New Construction; Yes to ❑ FHA/VA: Yes ❑ No , TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic >k: Distance from nearest well ______ _-Distance from foundation._.( _._..___.M,caf7ial___C,GF'F'iC3_Y� -____.___--, [ No. of compartments__-- -________________Size__, _ -----Liquid depth____ /C —---------capacity. ....... Disposal eld: Distance from neare t welL-��_____Distance from foundation _________.__Distance to nearest lot line___..... \ Number of lines______.___ _.__ __._____Length of each line____ __! 'S`"...Width of trench-__t ��------_-----_____ Type of filter material. �_ �(.__Depth of filter material_._�_ _f!______Total length____ . Seepag I : Distance to nearest weEl_-f- .........Distance from foundation___/Ag' )__..Distance to nearest lot line_�..___. Number of pits----:DL—_-------Lining material__V5 .Size: Diamefer---R-3-------------Depth---0..►5-----_____________ Cbsspool: 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):A------------•- -------- --- ------------- ---•------_----------- '�-� -----------------•-----------•-----------•------------------- ------------------------------•------ -----------------------.----------.-------------------------------------•------------------------•---------,--------------------•---•------•------••-•--•-•--•--•--•----------------- --•-------------------•-------------------•-----•----------•-•--- .---•---------------------•-----------••-------•-------------------------------------------------_------_------------------•_.----------,------------•--- - I hereby certify that I parer"Ahis,, ication and that the work will be done in accordance with San Joaquin County ordinances, State laws, a rul d ref the San Joaquin Local Health District. ( 9 ••-•---•--- (Owner and/or Contractor) BY: Ti+-- - - -- -------- ----------------•-- - • •-((Title) (Plot plan, showing size of I ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -------------------- ---- -•----•--------------- DATE... REVIEWED BY --- -- - -- --------------•---- , ----- ------------------------------------------ DATE--------------------------- BUILDING PERMIT ISSUED----------------------------------------- -----------------) #----- DATE------------- Alte�ratians, and/or recomme, atiorAS:_.-_x- 't -_..,1 "4_ ..:. ------ :.....f ----------- ��LC .-- •------ ---------•---•--- ----- ��--------------------------------------------------------------------------------- -----------•----------------------------- ----•----•-----•-----------------------------•----------------•-----------------------•------.-----------------------------------------------------•--------------------------------------- -.----- .------------------------ FINAL INSPECTION BY ._. ? :. ---- C `3�' r ------------------------- 6SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California (�} ES 9 REVISED 8-59 2M 5-62 ATLAS �11��