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FOR OFFICE USE: �'_ - 41------- 1 . n.•r1-------_Kr:9h.------ APPLICATION FOR SANITATION PERMIT Permit No. ..... ..._... /&� ------------------------------------------- (Complete in Duplicate) Date Issued -_._._alxk:- �i ____________________---------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit toiconstru and install the work herein described. This application is made in compliance with County Ordinance No. 549.Ail C'• ;�f �„�,� �... JOB ADDRESS AND LOCATION. - 4 -----------•------- ---• •.............••-•• --------------------------..... Owner's Name ------ -- - - - Phone Address-------------------------- ... r. .......... �'�''« --------------------- -----------------------•---•----------•- :.17 C Contractor's Name------._..___. � - Installation will serve: Residence ❑ A rtment House Commercial A ' Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms . . Number of baths -------- Lot size .___�_ __ .��_____________ �- Water Supply: Public syIste!tmi o••-Community-system-E]—Private %❑t 7 Depth To Water Table _Y ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)k Hardpan ❑ 1 Previous Application Made: (if yes,date--------------- ---) NoC. New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0 Septic Tank: Distance from nearest well_________________Distance from foundation------------.-------Material_______________.-__-.-_--------_---____-_______-. ❑ No. of compartments---------- ---- ----------Size------•-------------------------Liquid depth--------------------------Capacity--------•-•..:.....__- I Disposal Field: Distance from nearest well_________________Distance from foundation----:....____...___.Distance to nearest lot line_______.--------- ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french.............._.I---------------.--- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------- Seepage Pit: Distance to nearest weIIJ✓ .�---Distance fr fo rtdation__ ff Distance to nearest lot line---- _____ Number of pits.... ........... .Lining material__ __Size: Diameter___ .......Depth.___-.n --....._____._. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___________________.________________. F ❑ Size: Diameter---------------------- --------------.Depth---------------------------------------------------.Liquid Capacity---------------------------.gals. Privy: Distance from nearest well -------------------------------------___.......Distance from nearest building------------------ --------------------- El _----_______-____-_--•--___.___._.- ❑ Distance to neares#{lot line --------------- ----------------------------------- Remodeling and/or repairing (describe).-------• ------••------ ------------------------------- ----------••-----------•---•--------•---•------------------------------•-••-•----•------------- --------------------------------------•-------•------------------------------------------•-----------•-------=-------------------------------..._. ---------------------------------------------------------------------- --------------------------------------------------------------------------- ------•------•----------- ---------------------------------•-----------------------------------------------------------------------------------•-•-•------------...--------------•-•----------------------•---------------- 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. (Signed) Y ' _______________Owner and/or Contractor �Z Tit - BY� = l -' t�� = --------------- ------�- I 1e) --- --------- - --- -- ------ (Plot plan, showing size of lot, locoman of Sys in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__________ __ _ `` -------------- DATE---------tf_=P Y--.-. = ------- j REVIEWED BY--------------------------------------------- .._ .._.._.. DATE---•------------•--` ------------ BUILDING PERMIT ISSUED-------------------------------------------------------------- ---------------------_.....-_.._._. DATE-------•---------------------- -- A rations and/or ec mmendations:______ ---•-- .. --- FINAL INSPECTION BY: ---------- .. .... 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 TracYr California ES 9 REVISED 8-59 2M 5-62 ATLAS