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FOR OFFICE USE: ------------------------ ----------------- -- -------- APPLICATION FOR SANITATION PERMIT Permit No. ...... . --------------------------------------------------------- (Complete in Duplicate) - 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 County Ordinance No. 549. 2dO —/_3 ff / J'O ADDRESS AND LC ,FA>QC T - Owner's Name----------- -.....--- ------------------------------------------ -------------------------------------------- Phone. Address------------------ ----/j5.-.y-----.. ---------------......------•--------------------------------------------------------------------------------------------------------- Contractor's NameI ------- ------------------•----------- ----------------------------------------------- Phone.. Installation will serve: Residence 2g Apartment House ❑ Commercial ❑ Trailer Court ❑' Motel ❑ Other Eli Number of living units: .__!___ Number of bedrooms _-3--- Number of baths ..-- Lot size ...._�__ �`rk-_ --'�------=----•........... Water Supply: Public system ❑ Community system ❑ Private ® Depth To Water Table '70- 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 IW 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.) Septic Tank: Distance from nearest well---.S'0-.-----Dista cp from foundafion.-j4-----------Material---- -----_-•----•--------- - No. of compartments_____-___-_____..--_ -------Liquid depth------ -------- ---_____Capacity..LK_0'�----•. W Disposal Field: Distance from nearest well---47q-------Distance from foundation-___k9..........Distance to nearest lot line._ .......... Number of lines_______ _______________________Length of each line------Z.'IP'v----------------Width of trench .._-____.__..__-.-.- sType of filter material. 4A,94------Depth of filter material-----�__9-----_______Total length--�__G-P___---------------___________ Seep Pit: Distance to nearest well-__f_l1'___-_____Distance fro_m/foundation_.:A.`....__....Distance to nearest lot line.. �_�._.___.. IN Number of pits------2------------Lining material__; ut_------._Size: Diameter__;L'.1.t-frt.......Depth__-__1.9-----_-------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material...-____._____-___.___...._____•_--- r ❑ Size: Diameter--------------------------------------Depth-------------------------------------------------...Liquid Capacity..-------.._..--------------gals. Privy: Distance from nearest well._----------------------------------------------Distance from nearest building_._.___________-_______------------------. ❑ Distance to nearest 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. 5ined �� -- --------------------------------------------------r------------------------------------------------_-------------(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----J•7/1-4-7 � �-------------------------- - ----------- REVIEWEDBY---------------------------- - ----------------------------------- DATE_._...._.----------------•---------------------------------- BUILDINGPERMIT ISSUED---------------------------------------- --------------------------------- DATE------------------------------------•--•--------------------- Alterations and/or recommend'atitons----------------------------- - ---------•-•----------------------------•------•-------••---•----------•--------------•------------. -------•--•••------------------•------------------...----------•--------------------------------------------- ------------.---------------.------------------------------------------------- 6`•�- G' FINAL INSPECTION BY,��.r--�--'-=��1---•------------------------ Date--- ----------- ------- --------------------- ....------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Strout 205 West 9th Street Stockton,California Locil,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS