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FOR OFFICE USE: ......................................................... -_.11.,11--------------1111____-_. APPLICATION FOR SANITATION PERMIT Permit No. ._! ._ ! (Complete in Duplicate) •. ; Date Issued ...........:....... .. ..._.,f................................... This Permit Expires 1 Year From Date Issued •„pplication is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the w FkAherein d ibed. Yhis application is made in compliance with County Ordinance No. 549. 0-1 — pec-Ls- C� R JOB ADDRESS AN CATION--/--• ".."`- .............. �=� •---•- - � �.._ �•o Owner's Name. '.'._. ..- -----....--.._.......•.._••.... Phone. - -..........- Address----•----- I ._ --- .. __. ... -•--••....••-••-•-•......----•--•.._..._..•••...-.....-•..................•. , •-- Contractor's Name....... - ---• Phone_.... �.� ------- ------ - ---• ---••- ----- ---- ------------- ------•--------...----11--11-----..._ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _.I___ Number of bedrooms ......... Number of baths A.... Lot size ..... Q• ----------��-f� Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 1.111_. ft. C Character of soil to a depth of 3 feet: Sand [:] Gravel ❑ Sandy Loam 111Claa y Loam Clay❑ Adobe❑ Hardpan a II Previous Application Made: (If yes,date....................) No ❑ New Construction: Yes ❑ No ❑ FHA/VA:Yes❑ No❑' �-..► TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool.permitted.if public sewer is available within 260 feet.) ' I i y r i • Septic ank: Distance from nearest well-___r.�--_---._Distant? fro�r, foundat;cn..___/.A?....._.Material...... ! .............. No. of compartments_--_.._.'!�"". __----.-_.Capacity.-PO-111r.: S;ze._ .X.._.7..`X-.s�`'_Liquid depth-.__-..�_-�- Dispos ield: Distance from nearest weir.A".._..._Distance from fou�i-d tion__.1.0!-__._..Distance to nearest lot lines......... Number of lines...I-__.1.........!.............Length of each line:T ............Width of trench.._.?r.�.............111_--._.. Type of filter material../-srvrRr!,--------Depth of filter maters 1:--.-�g-��......Total length__._. �.�:.0..................... Seepage Pit: Distance to nearest well.,..*................. from fouridati n.__.___-..._____..Distance to nearest to`•ne..............'__ © Number of pits_._:l ..............Lining material........................ Depth..............I....... Cesspool: Distance from nearest well................Distance from�4 uridation_-.:__...-_;...._.Lining material...................................... ❑ Size: Diameter......................._fi___-_......Depth_.__.-_-..__.. --__--_-_,._._.Liquid Capacity................1.111_......gals. -• ., -•-•- --- r'rivy: Distance from nearest well.... _ .:_�.. :�__..........................Distance from nearest building.___-..-_--_________________--._-___-_. ❑ Distance to nearest lot -------•....................................................••----......-•••-• �._..-.._.. Remodeling and/or repairing (describe) = ........................ ......--•--••-••-••...._..-•••-----••-•--••------....•••-......-•-•.....................•••--...__. l ..............--------------•--•......---••-......-•--••---:....................... --.--..--•---•---•-•--- .------•---•------•-•---...-------•-----•----.__....---_........................................... • % I hereby certify that I have prepared this application and that,the work will be done in accordance with.San Joaquin County ordinances, Stat s, and rules a •regulations of the San Joaquin Local.Health District. (Signed)---.._. . ..................... _-_.... .. -•- ...... • ..-• -----................... .................................... o and/or Contractor) By:....LA-- ------- ---- -- --- ; ._.._-•.................-----•---•-......-•-(Title)---...--•---•-•••---......-.-____................................ (Plot plan, showing sae of lot, on of system in relation to wells, buildings, etc., can be-placed on reverse sid4 FOR DEPARTMENT USE ONLY ° APPLICATION ACCEPTED BY-. _-•- ••----.. ............................................................... DATE.. 6 " REVIEWEDBY.............................................................................................................................. DATE_........_...__...-•---••••--..._...--••-•---••--•-..._._.. BUILDINGPERMIT ISSUED..............................................................--------------------------------------- DIXTE_2�;__-...----•---------•------------------.--___-__------- Alterationsand/or recommendations:._.....................•--•-- --------•-•--------------------------------------•---------••----•------------------.-----------------__------ ...................................................... .....................A.. /. ........----....... ..-•----.. _.._....... _.. = <...-•_..._-•---••-••--•--- ------------- ---•-•----•....-•------•---....•--._.._...---•---•--•------------•----•••----••-••---•' ................ .•----....._....-••--••---...........--_....-•--......................................................................--------------------------------------------------------------...................... FINAL INSPECTION BY lrs- .. .. .- .... . . Date._.�1�: --•--•.............................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stecklon,California Lodi,California Manteca,California Tracy,California 19 9 REVISED a-59 2M 5-62 ATLAS