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! rvK U IL-t USE: ---------------------------------------------------------- ----------------- ..-__---- APPLICATION FOR SANITATION PERMIT Permit No. _ .__... ..� (Complete in Duplicate) .7A This Permit Expires 1 Year From Date Issued `�� Date Issued __-- _/,.1, -3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and stall the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT N...___... - _- •-------- - 9 Owners Name-----_� -- - • -----••--------•-------.. Phone Address--------•-------------o--,p--•-- •- - Contractor's Name_ -••-------------- -----------• --------- ....-- Phone-------- Installation will serve: Residence Ej Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: l----- Number of bedrooms _0--- Number of baths . --- Lot size ..--- Water Supply: Public system ❑ Community system ❑ Private W Depth To Water Table --7_Q ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe❑ Hardpan-M' J Previous Application Made: (If yes,date-_--------------.--) No New Construction: Yes ] No ❑ FHA/VA: Yes No , U' TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---,6-`Q__' Distance from foundation-----�_Q... Material No. of compartments-.;-------------------Size ¢• 9 -t_4"_...Liquid depth---.--�---------------Capacity ...l_..z.o- Disposal Field: Distance from nearest well.rV`_-__---._.Distance from foundation-•�-�-'_...- ..._Distance to nearest lot Number of of lines-.--!, ___ ..___ _ __ ________ Length of each line--. __'--- Width of trench..- _''�_�•.,---•--_ Type of filter materia ------ -- Depth of filter material length__�.9T�_ { I ... ...-•--------••----• Seepage Pit; Distance to nearest well--/ ______--.Distance rom f undation--1.d._�-._--.Distance to nearest lot line--1rJ____•_ Number of pits_--t2•___-_..__-_±Lining material_- t -- �, -Size: Diameter------ -- •---------.:Depth--��".-----•-••--•----•--- • Cesspool: Distance from nearest well -------------Distance from foundation.-------------------Lining material--------••---------------•�----••--•- ❑ Size: Diameter----------------------------•---------Depth------------------ ------------Li Liquid Capacity------ -------- --- ---------gals. q P ---- Privy: Distance from nearest well-- -___-__--`_�:_"�'___-_ ------_--__Distance from nearest building------------------------------------------ Distance.,to nearest lot line____--____--------------------------------------- ••------------ Remodeling and/or repairing (clescrite)--------------- ----------- --- -------•-•------------------------------•------...--------•-----------------------------•--------.-----•---------•---------- -----••------------..........---------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County F brdinances, State laws, and rules and regulations of the San Joaquin Local Health District. jSigned) k (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). a ,FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._ - DATE-_. 'lam' a-' EVIEW-ED BY -------------------- ------- ---- DATE_ BUILDING PERMIT ISSUED--------------------------- ------•--------•-- ------------------------------------------• --------------- DATE----- ' Alterations and/or recommendations:__----__-_.__-.-- ------ ---•--- ----- -- -- m_-_---•---•-•- - ------------ ------- - ------•---- ------- ---•------------ FINAL INSPECTION BY--- - -- ----------- - 1 ---- -- -------- ------------- - ----------- Date -�-`�'.-.�-.. __ ---------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT I Nl,l 11-1_1 \_'A T30 South American Sfr��l '� 300 West Oak Street 124 SYcamors Street Stockton,California ZOS West 9th Streif Lodi,California Manteca,California ES 9 REVISED a-59 2M 5-fit ATLAS ;racYr California If _ s�