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FOR OFF# E US t ...i .61--- APPLICATION FOR SANITATION PERMIT Permit No. .. ---------------- --- -1 / (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. I JOB ADDRESS AND LO AT107�N ��,// C-------------------- ---- -------- --------------- Owner's Name-- Phone --- ----------•-------------- -------------....--------------------------------- -•----. Address--•.................•---........_. .. .------•-------------------------------...------------•-------•---••------------------•-•------ Contractor's Name.......---. ..... 7-- -••---------- •-----•-•---------------- ------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----/-. Number of bedrooms ..2—. Number of baths ---/-__ Lot size ____.7 ---._---- Water Supply: Public system ❑—Community system ❑ Private ❑ Depth To Water Table _60 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 12" New Construction: Yes ET No ❑ FHA/VA: Yes ❑ No 2K_-,-4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permi#ed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----- Distance from foundation_.I�.r ... _..... Material__��------------------- l� No. of compartments------_�_2 ------------- --qS_i? -----Liquid depth--.' -- ..--._ Capacity______..Ca acit Disposal Field: Distance from nearest well--------.---Distance from foundafion-AP---__-------.Distance to nearest lot line.!..._...... Length of each line `_______________Width_ of trench._____lf` ` Number of lines--------- - -------••----------•---...- - Type of filter material !V -----------Depth of filter materiall_$'_`---------------Total length-? ._.........._.____.______________ Seepage Pit: Distance to nearest well-- - ""-------------Distance from foundation--�� .-_ -_-_----- .Distance to nearest lot line.._......--_-- L7 Number of pits--.-/----------------Lining material-7 Rd64-------- Size: Diameter--.3a---------------Depth-----Zd_/------------------ Cesspool: iameter_ a_rr-----------.Depth---.Zd_/-.--------------- Cesspool: 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---------------------------------------------------------------------------•-------•-------------------------------------------------•-------- - 1 Remodeling and/or repairing (describe)-- -----------------------------------------------_-_-------------••-•------........-..---------------------------------••-----•--._._...---•----• r� ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------•-•----•---------------------------------------•--------------------------------------------------------.-------------------------------------------------------------------------------------------------- -------------------------------------------- -----------------•-------••-•-------•-------------•---••-----------------•----•-----------------•-------------------------------.....----------. __..-------------------- - 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 Joa in Local Health District. (Signed)---------------------_-------_- -------------------------------------------- ---- ----- ---------- -------•-----------------------------------------------(Owner and/or Contractor) B ----- ----------------- (Title) +' (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- t------- -------------------------------- DATE------1 =-----�- T------� ------ REVIEWED BY----------------------------------• —._._ DATE --------------------- p BUILDINGPERMIT ISSUED------------------_-- ---------------------------------------------------------------------------- DATE----------------------------------------------------------- Alterations and/or recomme da io s:-- 1---------------- -----------_10............. Ise ---------------------------•---------------- --------------- --------------------------------- ------------------------------------------------------------------------------------------------------------------------------- �- I FINAL INSPECTION BY: ---- ----------------- -------------• Date-------L-ff---- ..- .----- SAN 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 S-59 2M 5-62 ATLAS r