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P ryIV�1`r[l.t US�� ---- --- -----. 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. JOB ADDRESS AND CATION" -_-•- -- -, -------•-----------------------•--------•- ' Owner's Name.------ --- - ------- ... r� ---- ------------------------------ Phone.--•-•----•----••---------..._...-- Address.---�G�-st=--••--- � --•- ---�-- a ••------. . Contractor's N •------••----•---ame--------•--------------•----...-•---------•-•-------- ----------------------------------------•-- Phone`Y Z Installation will{serve: Residence ❑ Apar+men+ House ❑ Commercial ❑ Traiie C ZX ❑ Motel ❑ Other Number of living units: ____.--- mber of bedrooms . "---_ Number of baths , - _ ` LOT size ..-.-- _.l P_.,X104: Water Supply: Public system Community system ❑ Private ❑ Depth ro Water Table©ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam Clay❑ Y ❑ AdobO W Hardpan [I Previous Application.Made: (If yes,date_. _ + +"---} No ❑ New Construction: Yes ❑ NOX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: { (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t j . 5 ti nk:� Distance from nearest well-----------------Distance from foundation---_-_--.- ----.Material_--__"---- No. of compartments---------------------------Size---------------------------- Liquid depth t ----- ---Capacity d: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line...._-_--_----_ Number of lines----------------------------------Length of each line---•----------------------------Width of french Se of filter material._. _----____" -Depth of filter material.------_- ---_. ,. - -•-=--•----Total length---------------•------••---•-------•----•- Seepa a Pit: I Distance to nearest well- DistanTem f ndation_- rjiQ� /�--_..__.. ;scan ce to nearest lot lineJ'"' 7-------------Lining materia Number of pits..--r - _ "-Size: Diameter----� Depth-----;?"^------•------- Cesspool I Distance from nearest well-----------------Distance from foundation .Lining material.---__--""-.___-_ ❑- ' „ Size: Diameter.--- -"Depth-------------------•---- --------------------------Li Liquid Capacity.. ............ gals. q j P tY _1---Distance from nearest well---------------------------------------------....Distance from nearest building ---------"...---. Distance to nearest lot fine-__"-.__-_"-- x '�R mo cling and/or repairin (describe):-- _" -••-------------- ----------------- -- ---- •. •--- -- . . r ------•---------------•------•---- --------------------- ------- ertif that I have "" -- - ------------------- ---------- Y y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, at s, and rule and �regulat' ns of the San Joaquin Local Heal+�i District. (Signed)-. - --- -- -- BY=--•........................................... ...--- r -- •-----------•----- - wner and/or d/o Contractor) or) ---..(Tifle)-.---- -4------------------------- (Plot plan, showing size of lot;locationof system in relat on to wells buildin etc., can be placed on reverse side). 1 i ..., _ � FOR EPARTMENT USE � NLY } APPLICATION ACCEPTED BY_ -----------•----------•------------•---------•- DATE_.- REVIEWED BY----------•--------- -- --- - ---------•----- ---...----------• ••---------------------- DATE_. --------------------- BiJILDING PERMIT ISSUED..................-r---•------------•-------- ---------- BUILDING PERMIT ------------------------- ----•-- DATE_ Alterations and/or recommendations: ") -----•-------- ---•-•----•-----•---------••--------- ------------------- --------------------------------- ----- ----------- -------------------------------- -- FINAL INSPECTION BY:-... -------------------- Date-- /. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 West Oak Street 144 Sycamore Street 205 est 9th Street Stockton,California � Lodi,California *. 1" Manteca,California, Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS y