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'FOR O FIQE USE: m , ' Permit No. __4 - . f . _ o APPLICATION FOR SANITATION PERMIT = ---�-- ----------------------- --------------- (Complete in Duplicate) �i ..............�---------------- ------..-...._- ..... This Permit Expires 1 Year From Date Issued Date Issued -----_.5.. 4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. t it JOB ADDRESS AND i, LOCATION C/ATION... .� ----- -----• •------ -- -- ---------------------------------------------•-••---•- ----------------•---------------------------- fir = U Owner's Name- -- .. .-...... ----- - Address f ContractorsName------ -----S---------••------------••-----------------------•---------...--•-•------•-•--•----•--••------ Phone........... Installation will serve: Residence g'Apartment House ElCommercial ❑ Trailer Court [3Motel C] Other 13 r I� Number of living units: ---1._.. Number of bedrooms _.�. Number of baths .1... Lot size .X -•--------------. .� Water Supply: Public system P' Community system ❑ Private ❑ Depth TO Water Table . ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff_ Hardpan ❑ Previous Application Made: (If yes,date--------------------I No ff New Construction: Yes ®'No ❑ FHA/VA: Yes ❑ No Z3' 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....Distance from foundation--- p.__.._......Material__ -PF.............................�...p.. I[� No. of compartments------4---------------Size---• - -x r.--•----Liquid depth__.-------------------Capacity...4��`--- Disposal Field: Distance from nearest well-----------------Distance from foundation_h`.__...........Distance to nearest lot ......... n Number of lines------1...------------------------Length of each line---..- ... - -----------------Width of trench..�_re----------- ------------ I� Type of filter material- G<<C--------Depth of filter material.../K_`----------Total length.....-c1� ----------------------------- Seepage Pit: Distance to nearest well-..._.—-----------Distance from foundation._.lp............Distance to nearest lot lina..�`i�...__.._ Number of pits./-------------------Lining maferiaL`?P�. ----.-Size: Diameter._.. 3...----- Depth_-...�.0-T_....__......... Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material------------------------------------- l [� Size: Diameter. ------------------Qepth------------------------------ - Liquid Capacity-----------------------•-•-gals. Pr•,i - ne---------------------------------------------- ----------•- vy: Distance from nearest well-------------------------------------------------Distance from nearest building------ Distance to nearest lot line ..-------------....----------------•-------------------•------------------- II ❑ . Remodeling and/or repairing (describe):-------------------------------------------------...-------------------------....-..-----------•--------.-.............................................. i u l -------------------------------------------------•----------------------------------------•-----••--------•-•----•--••------------------- la 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) -------- -- - -------- - ----------- ----------------------------------------------------------------------(Owner and/or Contractor) �. --------------------------------------------(Title)-----•--------------------------------- --- ---- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). !i i FOR DEPARTMENT USE ONLY----------- APPLICATION ACCEPTED 13Y.___,0r------ ---- ------------ ---------------------------- DATE---•� '� � �' � � � -------- REVIEWEDBY-------------------------------------------- -----------•----------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------••---------------••----------------------------------------- DATE----------_----- Alterations and/or recommendations:._--�'I.`.CJ�-- Y---r°CI—AeL -- 1-x,1 � _� -_._.... �._`_1 - --- -------------------- 3 �2 xr f . --- ----------------- !i 4 --•-------------------------------•-•---------- !I ------------- --------•--- 1FINAL INSPECTION BY:- - -------- --- Date--- I-LP. ------------ ----------------------•---- il SAN JOA UIN LOCAL HEALTH DISTRICT �+ 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street ll Stockton,California Lodi,California Manteca,California Tracy,California C E5 9 REVISED a-59 2M 5-62 ATLAS Eli