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,71Z OFFICE USE 7 --------------- ------------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. .__!._.1 ... ------------------------------ ----------------- (Complete in Duplicate) O Date issued ----------------------- This Permit Expires 1 Year From 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 CountyOr 'nance No. S49. " JOB ADDRESS AND LOCATION rA .Z 2'.. Owner's Name-- --------------------------- ----------•-------------- Phone.........................---------- Address.....7-3` --•------ Contractor's Name ------------------------------ Phone:.................................. Installation will serve: Residence 2--*A'partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units: ---I--- Number of bedrooms -'3---- Number of aths _2____ Lot size ---------------------------- Water Supply: Public system C] Community system [3Pri, Depth To Water Table ip_a_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San y Loam ❑ Clay Loam [jClay C] Adobe Gg--M-airdpan [3Previous Application Made: (If yes,date--------------------) No ew Construction: Yes �10 ❑ FHA/VA: Yes ❑ No ja TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest wg II_ Q______..Distance from foundation--- a..r._____..Material----ra-1:64-0— ......� ., No. of compartments__--Z--.-_____- __-_Size..... ___�' _.Liquid depth---- ! _Capacity c Disposal Field: Distance from nearest well-4V--------Distance from foundation-----O_______-___.Distance to nearest lot li a_S:t........... Number of lines_______________ ____________Length of each line-----, _ - --•..............Width of trench---- --- --y-_.........--------- Type of filter material.�V ......Depth of filter material---Ir-_'-----------Total length............FA------------------------' Seepa,g�e `t: Distance to nearest well_1,�_____-:_____Distance rl �foundation__M.............Distance to nearest lot line.-4f._-___.:. E Number of pits_____------------Lining material- - - _ ----Size:---Size: Diameter____—Z-. ._----_.Depth_._______----------.- Cesspool: Distance from nearest well_________________Distance from foundation....................Lining material------------------------------------- 0 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. (Signed)------------------------------------------------- ------• ---------------- ----------------------------•-----------------------------------_---------------(Owner and/or Contractor) By:------------------------ --•- ---•- -- •--- ------ ------- ---•------------------- -------•------ ------------------------(Title)--------------------------------------------- -- -------------- (Plot plan, showing size in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ------- --------- --- _ !-------------------.------- DATE........ f...... -. REVIEWEDBY--------------------------------------------- ------------------ -------------_------- DATE-------•--------•--•----- BUILDING PERMIT ISSUED----------------------------------------b�------------------.---------------------------------------- DATE------------------ -- -�----- ---�- --- ----- --- ____ ----- Alteration-�s and/or recomI�mendations:_!_�- _ -------•------- _-- ------- ... ••--- �- -- - ! - FINAL INSPECTION BY________________ ---- --------------------------------- Date_.. 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 REVISED 8-59 2M 5-62 ATLAS ° •`