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FOR OFFICE USE: I ------------- �" APPLICATION FOR SANITATION PERMIT _... Permit No. _ ...S. ------------------------------------------------ (Complete in Duplicate) 1 ? lDote Issued ...�-1.��-------•- TFiis 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 witli County Ordinance No. 549 "' JOB ADDRESS AND LOCATION _. rte . --- ------- ... ._. Owner's Name 1 -------- ----•-- Phone.. "i- Address-- �._.. �---.. ._�72 �.. -t -------------------- Contractor's Name.... 11-------------------------------------------------------------------------- Phone....... Installation will serve: Residence ❑ Ap Irtment House E] Commercial ❑ Trailer Court Motel Other ❑ Number of diving units: ___ Number of bedrooms -_______ Number of baths ____-___ Lot size ----------- --, �..; --------' ----------•-- Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table I.... ft. Character of soil to a depth of 3 feet: 5 IE]nd Gravel Sandy Loam [ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan F] # Previous Application Made: (if yes date__-----.__.__._____ 1 No ] New Construction: Ye''] No ❑ FHA/VA: Yes ElNo-� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep i Tank: Distance from nearest�iwell___��___--Distance from/ foundation --M,�jter al__ ._.__.._.____________________- No. of compartments-'Ll depth-----'2`�--------------Size.-. -- t' _- --Liquid capacity------ Disposal Field: Distance from nearest well_670__._._. Distance from founds ion..- P__ Distance to nearest lot line--A.1.. Number of lines..........:... - -------------------- Width of trench._41y__11 of filter material'�^�� ` Depth of filter materlal_. 'a e�.________-__Total length_______ _______________________ Seep Pit: Distance to nearest weld----------------------Distance from foundation....................Distance to nearest lot line---________...... Number of pits----------- ------Lining material---------------------.-Size: Diameter.............----------Dept h------------------•-------------- 04 Cesspool: Distance from nearest! well-----------------Distance from foundation-------------------.Lining material-----------------------.------------- ❑ Size: Diameter-------------'-------------------------Depth---- -----------------------------------------------Liquid Capacity-------------------------- Is, Privy: T' v Distance from nearesf�weld-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------------------------- -------------------------------•--•---•- -------------------------------- •--------------•-•-•------------- - Remodelin and or ra air! scribe :_ I___ i - '•"" 1 -' -r__'�rU`� --- ••• .------•-•-- 9 p V. { ) t - - ------•--------1--•----•----------------------------------•---••-•--------------------------------••---------•---------------------------------.--------------•------- i -------------------------------------- --------------------------------'--------•-------------.---..--------------------------------------------------------------------------._.-------------------------------------------- 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. Q- -----------------•---------•----- - --------- -•----------------------------------------------------------- -- Owner and/or Contractor (Signed) { / 1 By----............--------------------------------------�--•- -------------------------------------------------------------------------(Title)--.-------------------------------------.......----------------- (Plat plan, showing sixe of lot, location oflsystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ---------------------- - -- ------- ----------._.. DATE REVIEWEDBY--------------------_- --------------- ---!I-------------------------- ----- ---------------------- DATE---•-----• - '--.. _-------- BUILDINGPERMIT ISSUED---------------------- ------------------------------ - -------------- DATE------------/------------------------ --------------------- Alterations and/or recommendations:•---- I--------------------- -------- -- -------•----------- � _.._______.____________________________-_-______-.--__._-.-._____.____,i..__.__-__._____-------------------------....---------------------.__.__....._.----------------------.-----------.--------------------------------- ----------------------------------------------•-I—— --------------h------ ----------------------------------•----------------- ---------••---•-••------------------------------•---------•------------------------------ --------------------••-------------------------------------`i------ ------ -------• --------------------------------------------•------------------------------------•-------------------------------------- ------ FINAL INSPECTION BY:..--- =----•-- - ° C___-------- Date------ ( / 2� ._... _ --------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 west Oak Street 134 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California I ES 9 REVISED 5-59 21A 5-62 ATLAS '