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rUK USE: ----------- ------------------- .____-_. APPLICATION FOR SANITATION PERMIT Permit No. ./. X.-3k7/ --------------------- -•---- (Complete in Duplica+e) _ ---------------------- ----- --- ----- / This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San JoaquinLocal Health District for a permit to construct and insta%ll the work herein described. This application is made in compliance with County Ordinance No. 549. O AIjDRESS At0DCL_AT.IIV A -------- wners ame__ -------------Address. t � ^.._..__ Phone---------------------- - Contractor's Namr ` Phone Installation will serve: Residence 1 Apartment House ❑ Commercial ❑ Trailer Court I ❑ Motel ❑ Other ❑ Number of living units: -----/ Number of bedrooms . -_ Number of baths _/--- Lot size ______- __._______.._ --------•---------- Water Supply: 'Public system ❑ Community system ❑ Private K] Depth o Water Table .7a__ 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 [E New Construction: Yes W No E❑ 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: x Distance from nearest well----- ----------- Distance from foundation,------------------.Material... ----------------•---••-----••---...__...__. [] No. of compartments -----------------Size-------. ------------------•_---Liquid depth Capacity p � le Dispos Field: Distance from nearest well...X0-------Distance from foundation.__40----------Distance to nearest lot line__S.`._-_•_ Number of lines__—__._f______________Of__ Length of each line______Z, '�_ 01 ----_-----Width of trench-- ----11------------ Type of filter material._.�=f -__---_-Depth of filter material____--$_-_-_----_-Total length-__73'- -••----------------•- Seepage Pit: Distance to nearestwell _______--------------Distance from foundation...........i_.---.Distance to nearest lot line__...-____.-__.-- ❑ Number of pits__- _-Lining material------------- ---Size: Diameter`'------------------_'Depth--------- Cesspool: Distance from nearest_w�ll______________ �,D'istance,yfrom foundation---------------------Lining material------------------------------------- I ❑ Size: Diameter- ' ----------Depth--------------- ----------------------- - - ----- --Liq Capacity -----•----------------------Liquid Ca ga11 1ls. 4 Privy: Distance from nearest well_____________________________ Distance from nearest building--------- ----------- Distance to nearest lot line___------------------ - ----_ , 1' � Remodeling and/or repairing (describe):___-------------------------- ........ •-•-- ---------------------------------- hereby -arid-}hat-+h-------------------- ---------- � -•-••------------• --------••---------•----------• ------ • ---•-- e work will be done in accordance with San Joaquin County ordinances, Sceffiftate I y that I have.prepared this ap'plieatioil S, and rules and 'regulations of the San.Joaquin Local Health District. o e_ , (Signed)--------•-- r �.. ----------------- -------- =-----------= ------ - l[Oxaez and/or Contractor] BY= . 1 (Title) ---- ---- ------ ---- -------- (Plot plan, showinq size of lot, location`of system in`re ation to wells, buildings, etc., can be placed on reverse side). A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------ ------------ - - --- DATE_._Z-;0 -G 3 REVIEWEDBY------••-=---------•------------------------ ---- - •- -------------------------------•---- DATE---•--------•-- UlLDING PERMIT ISSUED.----:-.---•-------_-_- •---•-......---•---- ------------ •----------------- --------------------- DATE Alterations and/or recommend'a+ions:--.---._-___._...----__ ---------• -----------•----------- - ---------- •------•-----•------ ---------------•-----------••-----------•--------- , -•--•---------•-------- ---------•-----------•------ --------------------------- ---------------------------- --- --------------- FINAL INSPECTION BY:,��.-..-- �� . . ......•-- --------------•--------------- Date.-/' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 174 Sycamore Street Stockton,California205 West 9th street ES 4 REVISED 8.59 2M 5-62 ATLAS Lodi,California Manteca,California Tracy,California