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FOR OFFICE USE- o Permit No. .. .__5_ e r J�_ ------ e --- APPLICATION FOR SANITATION PERMIT 1�- ---------------------L�- .-y-�_ �--- (Complete in Duplicate) 0� -___-_.___ 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. JOBADDRESS AND LOCATION -----------------••-------•-------------------•-------•--------_--.............................------- Owner's Name--- - •--- ------------------- Phone.................................... R - Address------ --------------------------------------------------------•----•--------____-----------------•-•-------------•------.----__......................................... Contractor's Name.. -`-�---`--7"5------•--------------------------------------------- ------------------------------------------------ Phone.......................-.-----•--- Installation will serve: Residence 21"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _j____ Number of bedrooms ---3--- Number of baths _j.-_ Lot size _____________________________________ Water Supply: Public system ®Community system ❑ Private ❑ Depth To Water Table 0.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ' y Previous Application Made: (if yes,date--------------------} No 2`_'New Construction: Yes_ No [!rFHA/VA: Yes ❑ No ❑� 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___________.------.Material_________-_-.._______________-__-__ --------- ie __--__. ' No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity....._......- Dispos Fld�l Distance �rom nearest well----�___-__Distance from foundation._�__e1____.__..__-Distance to nearest lot line__ ____________ ��Y/�� Number of lines_-___-___ __ Length of each line_______��____________________Width of trench__2 �.__________........- p►�� Type of filter material__-.77p!:A_--_-__Depth of filter material---- _r___............Total length____ ............................. Seepage Pit: Distance to nearest will____ ______________Distance from foundation_-�Q__-__--..___.Distance to nearest lot line��_.__...... Number of pits------- -- ----------Lining material-----_1ZaSize: Diameter----33_r..-________Dept h----- Z4 --------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_.-____-_____-____-_________-....... W ❑ Size: Diameter--------------------------------------Depth------------------------- - -------._Liquid Capacity-------..-_---------------gals. Privy: Distance from nearest well------------------------•-----------------------_Distance from nearest building-----_-__-----------------.-_------______- ❑ Distance:ao nearest lot line------------- ----------•----------------------------•------•------•--------------•--•------------- ------------------------------------------ Remodelingand/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 regulationsAtan oaquin Local Hea{+h District.Si ned ------ -----------------••-•-•------------------------------------- (Owner and/or Contrectorl ( g ) ----------=----- $y:-------------------------------=-------•-••.------------- ------- - ------------------••-----------------------------{rtle)-----------------------1------------------------- ---- ----- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- `�� ------------------------ DATE__ _r.:. .....- REVIEWEDBY--------- ----------------------------- ------- ---- --------- DATE BUILDING PERMIT ISSUED._.. -------------------------- DATE Alterations and/or recommendations:-_________�� /.'��-""I -Z-11---L -'"Q —�J' -' -•�- `�...... . --` --:-------------------�- ` 'tf :: : ::= : :z:-::----.---.---•-•--_- ----------------------------------------------------- 1------------------...-.-. -----•--•--------=-- --•-------••- FINAL INSPECTION BY:...1,/t ----------- Date------------------------------------------ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 390 West Oak Street 124 Sycamore Strout 205 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.59 2M 5-62 ATLAS .71