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----------rUi< urrl5t�0t:J - - ` - �. - F ---- 3 APPLICATION FOR SANITATION PERMIT Permit No. ...�_ _7...J.t --------------------------------------------------- (Complete In Duplicate{ r 17 --- This Permit Expires 1 Year From Date Issued 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 CountyOrdinance No. 549. JOB ADDRESS AND LOCATION.� .--`--- -•--�—----------------------------------...._...._-----...--------------------•----...........--------.. .. Owner's Name--••---- -- ------- ------• -- - ----------------------------------•--------------------------------- .._..-- •-------.. Phone....................--------------.. Address.-------- � •. . -- .. ...................................................•........................................................................................•............ Contractor's Name-------- --------------------- ------•--•-•------------••------------------------------------ •---• ....................................... Phone................---••-------------- Installation will serve: Residence [I Apartment House ❑ Commercial ❑ Trailer:Court ❑ Motel ❑ Other ❑ Number of living units: -__ of bedrooms 3___ Number of baths __/-___ Lot size ___/ pk_/ ? ?................................... Water Supply: Public system M--l—community system ❑ Private ❑ Depth to Water Table -JT. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] i,Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------I No 9?'/� New Construction." Yes ErNo ❑ FHA/VA: Yes ❑ No ®r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SFptic nk: Distance from nearest we11 C____Distance from foundation--/P-. "'_W`..................... ' [ No. of compartments.:-Z-------- Size.......ZX-S-_x-jF---_---Liquiddepth----- - -------------Capacity__.?'P_V_C/ i Disposal Field: Distance from nearest walk- a..4__.Distance from foundation._��-------- . ..Distance to nearest lot line.. ...._.. Number of lines---------------- Length of each line-----...70-"------------..Width of french........�`✓..:".------.......... i . Type of filter material...-'? A4_._._.Depth of filter material___-/V'__ length.............!'f�•____--_-_-----__-- Seepage Pit: Distance to nearest ell_ _______Distance fr fou dation--1.�P.�___..___.Distance to nearest lot line-.... Number of pits-___:: _-_.__Lining material..._ C .Size:.Diameter.__"?P?K...._..____.Depth--------2A _____________ \ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material............................... ...._._ �J ❑ Size: Diameter-------------------------------------De th.__------------•---= ----------------------------_Liquid Capacity. gals. Privy: Distance from nearest well______________________________________ _-.____Distance from nearest building_-...___._______________•-----_--______._. ❑ Distance to nearesf lot !ine------------------------------------------------------------------=-------------•---•----•---------------....---••--•-------------'._..------- Remodelingand/or-repairing (describe):------=•-----------------------------------------------------------------------------•---------•---------------•---•------••---•----_--•---••-------- ---------------------------- -----------------------------•-•---------------....--------------------------- ------------•-----•------------------...--•----------------•-------------•---------.---------------------------------------------- I hereby certify that I have prep + s,application and that the work will be done in accordance with San Joaquin County ! ordinances, State laws, and rules an r g tions of the San Joaquin Local Health.District. ----------------------- :.{Owner and/or Contractor} (Signed)•-------•----------------_ ---•--- Br---••-•-----------------------------•-• ---••---------- -------------------------------------..........................-...(rtle} (Plot plan, showing size of lot, location of Sys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------------------------------------- -----` . . DATE_...-----1-- ... --V-------------------------- REVIEWEDBY----------------- ------------------------------------------------------------- --------------------------- --•-- --- DATE---•----- --•--•----------------------------••-------------- IBUILDING PERMIT ISSUED---------------------------------- --------------------------•--------------------------------------- DATE------------------••----------------._...---------•---- 1 Alterations and/or recommendati ns:.___•-----------------�-- --- -- - -- - ----- --- ' FINAL INSPECTION BY:.----x.. e---- ------ li!�,.,�------- 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 EB 9 REVISED B-59 2M 5-61 ATLAS