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. ......--- ---- -- FOR OFFIC,ErlJS� � . r - APPLICATION FOR SANITATION PERMIT Permit No. .............�.._7� ------------------------------------------------------- (Complete in Duplicate) �/ ------------------- This Permit Ex ires 1 Year From Date Issued Date Issued .._.. ..f..__C 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 Counb a No. 549. JOB ADDRESS AND OCATION---7____________ _ _ _ _ _ � j.� ----------••------•---------------•-----......••....................................... Owner's Name-_ ..-•------------------------------------------------------------------------••-----•------ Phone............•---------------•---- �3-... .. Address ._ - Contractor's Name......... - •-•-•- Phone................................... p---------------•----------❑--------------------------❑---------------------•--------❑- Motel ❑ Other [-IInstallation will serve: Residence A arfinent House Commercial Trailer Court Number of living units: __:_ _. Number of bedrooms Number of baths __2.. Lot size .z5:f_X.j%07Q................ ............... Water Supply: Public system [rt�ommuriity system ❑ Private ❑ Depth to Water Table _ I ft. Character of so'sl to a depth of 3 feet:' Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Clay [I` Adobe�rHardpan ❑ Previous Application Made. (if yes,dote____________________) No New Construction: Yes �o ❑ FHA/VA: Yes ❑ No ❑-� TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ankh Distance' from nearest well_________________Distance from foundation_____--_---_---_Material___.________________----------------....___-___-. No. of compartments--------------------------Size-----------------------•--------Liquid de}nth--------------------------Capacity- - Disposai` ield: Istance from nearest well____ stance from foundation---- t../..Distance to nearest lot line...... umber of lines_____._ __ ----------------------Length of each line--------- )I/Width of french---------� f. ........... Type of filter material-_- ( /_____Depth of filter material--------- length---------/-------------------- -fir--- Seepa Pit: Disfance to nearest w -__Distance from foundation_--r.�?......._..Distance to nearest-lot line__C5---------- Number of pits________ _________Lining material__707?p_Cf_.Size. Diameter---33_6j_...__-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--------------------------------------------- •...... Remodelingand/or repairing (describe)= ----------------------•-------•-----------------•--•------•-------•---•-----------------• .....................---------........................ ---------------------••----•-••-•-•----------------------------......... - ----•----•-----------------------------------•------------------------.....----•---------...---•----------------•__----------------------------- ------•......................•------------------------------•- ----•• -------------•-- -------------------------------------------------------...----.----------------._.....---•-----------------------------•-------- I hereby cert' I have pr r this appl' tion and that the work will be done in accordance with San Joaquin County ordinances, State laws, a rules tions. the San Joaquin Local Health District. .'(Signed)--------------------------------- ---- ------------------ ----•--------------- -----...---(Owner and/or Contractor) By:--------------------------------------------------------------- ------'-----------------------------------------------------------(Title)--••----•--------------------------------.........---------•---- (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). K�RDYARTNOT U E ONLY APPLICATION ACCEPTED BY-- -- ----------------------------------- - ..-- REVIEWEDBY----------------------------------------- - ---------------------------------------------------------------------------- DATE PERMITISSUED-------------------------------------------------------------------------------------- -------------- DATE------------------------------------ Alterations and/or recommenc{ations:------------ -----__ ---------------------------------------------------------------------------------------------------•- ---•-•-•--. - ------------------------------------rl---------------------- ------------------------------------------- ---------------------------------------------------------------- •- • ------------------ FINAL INSPECTION BY:....... 1.._ z9--- - Date-- ... -----r--- � Z - f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Locil,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 6-6[ ATLAS