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l ..Y,. • ----- - - ---`` APPLICATION FOR SANITATION PERMIT Permit No. .._.:.__... -- /. � (Complete in Duplicate) Jl ' This. Permit Expires 1 Year From Date Issued Date issued .... Application is hereby made to the San Joaquin Local Health District for a-permit This application is made in compliance with County Ordinance No. 549. to construct and install the work herein described. JOB ADDRESS AND LOCATION...__•------- � 0?le-1 Owner's Name............ ------•------ •--- Ci� �.. ------------------------- --------------------------------..:-----. Phone._, p Address... -. _._ v'.J. .. .I •--- •------- • q Contractor's Name----- •( _ .f --------.... �. Installation will serve: Residence,p( Apartment House Commercial Phone __ _ f!� ❑ Trailer Court ❑ Motel ❑, Other ❑ y Number of living units: __ __ Number of bedrooms _ Number of baths /--- Lot size _.__._.1�Q p Water Supply: Public s stem '--'�--�---`--�-----• Y ❑ Community system ❑ Private D< Depth to Water Table�_..__ 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 T New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publif sewer is available within 200 feet.) Septic Tank: Distance from nearest well_- p-------Distance k0ni #0undation__/11�---------.Mater�l-----• ?(, : C�k No. of compartments------�--------P.---Size.:_--}�;.� �'----Liquid depth_.._..:'------ - -- Cepaclty.•� ,Q �r I r Disposal Field: Distance from nearest w II_ ® .Distance from foundation---/O.___---__--Distance to nearest lot line.-._�__..•_ � �Number of lines___'____.._ ,- - -._._Length of each line a idth of french___-___. Type of filter material.....---••--------_--- Depth of,filter material_ _..__ •---•---"----- --..---•---Total length.__. f•. t^ r Seepage Pit: Distance to nearest well______________________Distance from"�.foundatio ---w--�- . i ._-_ _ - ., _j ..Distance to nearest lot line................. ❑ Number of pits.... ----------------Lining material__.____. . _- - "-- -- i Size: Diameter------------•---------_.Depth------- Cesspool: Distance from nearest wel!___.________•--_-Distance from foundation_--._.____!_-__--Lining material_._--__.__._•--___•-•-_••-- ❑ Size: Diameter----------•- ---•--Depth..--•- i ---- -•-------- ---- ------Liquid Capacity Privance I - q -�--------------------------gals. rest well-----------------------•---------------- om Dis+ante from nearest building.......................................... ❑ Distance to nearest lot line________________--•------_--•- # I ' ---•----•----•--- Remodeling and/or repairing fdesctibe):______--------------------- --------------'-�---- , -- --••-.......... -••--------------•--------- ....... .----------•-•-- ------------••-- ---- -F....-----^---------••-----..---.___.-. ------ --- -- 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) I I ------------------------------------- --I----------------_---.(Owner and/or Contractor) By:. -•--•-•-----•--------•-- I -----------------------------(Title)------------•--------------------•. ----- Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY/�r_ REVIEWED BY DATE__._ tLi -j+ --BUILDING PERMIT ISSUED... --- ---------- DATE--- ------- ' - - - __-•- ----•----------•------•----•--------•---------------- -------------------------- DATE.Alterations and/o reco endat�nV /�------------------ --------------- ------------ ..~- e °--..c-a ''!- - a - ._. -- ` • .—I, Z`,�_...�- - ---------- _--- , _ /� -•------- �-(� _ _F___.,( ____ G.. ___..._---..____.__-.___. ------------------------------------- __ ______________________________________________ ____ -__._ FINAL INSPECTION BY' _,_... "...` '"�- Da+e__� C f •C SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sino! 300 wool Oak Street 124 Sycamore Siroot 205 West 91h Street. Stockton,California Lodi,California ES 9 REVISED 6-69 8M x-61 ATLAS Manteca,California Tracy,California a _ 4 _