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FOR OFFICE USE: -------------------------------------------------- - -- Ar�.7.../ ------------------------------ -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. —Ara .. ----------------------------- ------------------ -------- (Complete in Duplicate) Y ------------------------------------------------- ------- 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 Zlsma�de iNl with County Ordinance No. 549. compliance 011 S—�a ^O 2-- JOB ADDRESS AND LOCATION- -----• _---- - ----_------'"fit-- -• ---orf------------• -- '�f_------- •-- -• - y ,,�, �O ` �y '`.'� - - ------------------------------------------ Owner's Name '-"r-'y"' �`" I Phone Address------------- . `..- ' . yY -------- ------------------------------------ Contractor's Name--, ?.c_1110"*11 "-------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: �idence 0 Apartment House C] Commercial E] Trailer Court E] Motel ❑ Other [I Number of living units: -------- Number of bedrooms,_------- Number of baths ----.... Lot size -_01W4L* --------------------------------------- Water Supply: Public system ❑ Community system ❑ Private K Depth To Water TableT Q--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: 11f yes,dote--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic T,on Distance from nearest well-----------------Distance from foundation--------------------Material-----------------------------._...-------------- - e ` No. of compartments--------------------------Size----------------------- ---Liquid depth--------------------------Capacity-----------...-.------ I isposal Field: Distance from nearest well--10---------Distance from foundation--Ab--_--------Distance to nearest lot line-s_ ........ Number of lines-------l.--.-_--------- ----- Length of each line------1-1 a---------.......Width of trench.__'1-1--_---------------_------ Type of filter materia�'1� --_--Depth of filter material...I.%---------------Total length----t�p-!............................. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- F-1 Number of pits----------------------Lining material----------.------------Size: Diameter----------------.-----•Dept h------------------_----_--------- 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-------------------------------------------------•--------------------------------------------------------------------------------------- 11 Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------•------------------------------------------------------1X -------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------- 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)---- -- ----V. + -•-- -- --- -- -- ---------------------------•---------------------------------------------------(Owner and/or Contractor) By: (Title). (Plot 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--- ------------------------------------------------------ DATE---- 1-- REVIEWEDBY-------------------------------- -•-----•- -- ---------------------------------- ------------------ DATE ------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------- --------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------------------------------- ------------ --•--•------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------•--....--•-------------------------------------- FINAL INSPECTION BY:.t/!` + r # Date 'Z '. �' ..- y. .. ------------------------- 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 ES 9 REVISER a-59 2M 5-52 ATLAS k