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FOR OFFICE USE- --------------------------------------------------------- SE:-------------- ----------------------------------------- - ------------- -- APPLICATION FOR SANITATION PERMIT Permit No. ..1_.._-� . .. ----------- ------------- -- -------------------------- (Complete in Duplicate) cf - This Permit Expires 1 Year From Date Issued Date Issued ................... 3 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--- ---/�-- �'-------------------------------------------------------------------•---_..--------- j Owner's Name I Z4,e ` anis!`--- ---------------------------- Phone........................•----------------------- I, Address.......... � ,2 _. . ..�"1� .� - -- ---- -- - - - - - Contractor's Name---- �� -•--------•-------------•----•----------------------•-----•--------------------• Phone Installation will serve: Residence [R--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _A___ Number of bedrooms J- Number of baths .1____ Lot size ----Ta---A.12. .............................. Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table .:kdit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay El Adobe Cr--Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes 9a"'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well ________Distance fromfoundation1t. 'i __________________________________ �___Septic nk: f _ _ /2 No. of compartments_-__.&_____------___Size_____-3. xf_Y_q.___Liquid de th.__- 1 ____._--------Capacity-.-•�¢-d_ .f7 r Disposal Field: Distance from nearest well---- ----------Distance from foundation.Z.0._____ _I Distance to nearest lot line.47._....... �' Number of lines_____I_________________ ________Length of each line- '7�7 -62_.Width of trench._.-.�., ... .______.______.._ ('n Type of filter material._" o t_�1_...__Depth of filter material_..I r._`_-___ ._Total length____-9 0.............................. v 1 �lvo U1 Seepage Pit: Distance to nearest well ell______ ___________Distance from foundation-..- ......_____.Dista��t nearest lot line...-v'�---.._...._ Number of pits-------- __________Lining material_____ Cl ----Size: Diameter __Depth----.0_;P_45-7- .... Cesspool: Distance from nearest well_________________Distance from foundation---.--------------- Lining material------------------------------------- 0 Size: Diameter--------------------------------------Depth-------------------- •- ----------------------------Liquid Capacity-----•-_----------.------gals. C Privy: Distance from nearest well--------------------------------_--------_-------Distance from nearest building_--____--__--_-____-_-.--___________._. . ❑ Distance to nearest lot line---------------------------------------------------------------------------------------•-----------------•-•----•---------------------------- Remodeling and/or repairing (describe):--------------------------------- -------------------------•-----------------------•---•----------------•------• ---•-----------------•--------._....---- --.---------•--------------------------------------•-------•----------•--•----•-------------------------------------------------------------------------••---------------------•----•-------...-----•----------------------- , -----------•---------------•-••----------••--------------------------------------•-------•---------------- ........ --•------------------------------:-•----------------------------•-••--------------------------- -- ; -----•-•------------------------------------------------------•------------------------------------•-•------------------------------------.-..------------.------•---•--------- ---------------------------------- i I hereby certify that I have prepared this application qhd that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o he n Joaquin Local Health District. } 3 (Signed)-----------•--------------------------------- -------------- ------- ------ - -- - -- --------------------------- ---------------------------------------(Owner and/or Contractor) a By:----------------------•----•------------------------------------ ------ ------------- -------------------------------------------(Title)---------------------------------------- . ....._.-------------- (Plot plan, showing size of lot, location of system n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY A '"'`�---•---- ------------------------•--•----- DATE.... =� 3 ,•----------- REVIEWED BY - -------------------------------------------•-- ---------------------------- DATE----------------------------- , ------------------------------ BUILDING PERMIT ISSUED-_...._..-_------------- - DATE---------------------------------------------2-------------- Alterations and/or recommendations:_-____ ... ............ 'rte..-.: --------------------------------••--------------------•--------------- -----------------------------------------------------------------------------------------------------------------------------------------•-----•.._.................... ----------------------------------------------------- ----------•------------- -------- ------ --------------------------------------------P----------------------------•--- --- ----------------------------------------------------------------------------------- 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 E5 9 REVISED B-59 2M 5-62 ATLAS