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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .__� (� l.. --------------------------------------------------------- (Complete in Duplicate} Date Issued .. w `.1�....--•-•- ______________ _._-_-_.___...____ -----_.___._.._ : s Permit Expires 1 Year From Date Issued -� Thi,,,__, Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described r This application is made in compliance w' County Ordinance No. 9.� I/ it JOB ADDRESS AND C ION... -- ._...•• ¢� -� If Owner's Na e---------- k !.!!I.� { •C�S�:Zg�- Address--- --- ----•---....-••.--..-------•-- ; --...!_-.--•• - -- ...�-�-I- -;------------------------- --/.......... /........ n...... Contractor's Name--•--•---- .... .. ... ---- ------ -•-----•----------------------------••---•----.. Phone. .E?_ _ �[?.�_.[-_.__ Installation will serve: Residence [5-"Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _ Number of bedrooms _4?. Number of baths .-/-. Lot size _... ... .......................:.. Water Supply: Public system l Community system El Private [[Depth to Water Table�.2__ tt. ,M. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan❑ .IIS Previous Application Made: (Ifyes,date--------------------) No ❑ New Construction: Yes to ❑ FHA/VA: Yes ❑I No [I!� , TYPE OF INSTALLATION AND SPECiFICATIOIN _. r (No septic tank sPlpM , lyP permitted if seweravailable within 200 feet.) , --' --- .........................Septic Distance nearest wel3 Distance from foundation__/A-------.Matw__�__ ---�r '�• lo?,444 No. of compartments_._____:_____________Size_,5Z.. .......Liquid depth___/--------Capacity./Qjv ... 0 r i V Dis osal eld: Distance from nearest well.-S--[�.___._Distance from found``ation.V..Q__......pistance to nearest lot line..,S_ ...... ,,p� Number of]�lines--------9----- -- ------------Length of each linel�L�?--,�,e9?JSIO..Width of french-------.. _ --------....... Type of filter material__ �. L4C_ ___Depth of filter material--��y_________Total length..........2--,VD`___________________ Seepage Pif: Distance to' nearest well-------------------_-Distance from foundation--------------------Distance to nearest lot line---______._.. _ � C1Number of pits----------------------Lining material......-----------------Size. Diameter--------"-------..__-_Depth.-------------------------------- - Cesspool: Distance from nearest well----------------_Distance from foundation,--------------------Lining material----------.-------------------------- - Size: Diameter--------------------------------------Depth---------------------.. ------------------------Liquicl Capacity---,................ - gals. Privy: Distance from nearest well---------------_-----------------_--------------_Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line---------------------------------------•----------...---------------•-----•-•------.i_....------------------------------•----- ------------ t Remodelingand/or repairing (describe):------------------------------------------=----------------------------•---..................................................................--------- -------------------------------------------- -------- ------------------------------------------1M---------------------------------•- -----------------=-----------------•-----------------------------------------.----------...-...----------------=............ ... -----------------------..........•-•----...--------------------------------- ----------- ._..�....... - e I hereby ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, at laws, and r I'es and i ulations off the San Joaquin Local Health District. I ,_/ - -- ---'--•---------•---_- .... nor end or Contractor (Signed)---- -- ...i. / 1 Y� -- e17- t [Plot plan, showing size of lot, locatiion of system to relation to wells, uifdings, etc., can be placed o reverse side]. . FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------------------------------------------------------•-----•--•-•---------------- DATE------------------------------.....................--•---- REVIEWEDBY-----------------------------------------------------------------------------------------------------....... ---------------- DATE............................................................. BUILDINGPERMIT ISSUED....!I----s---•------------------------------------------------------------------------------------- DATE-----------------------------------•-__- ........ 4 4�t, Alterations and/or recommendations:---- -----_ :.- !� Y---------------------------------------------- ---- !!I I .. ---------------------------------------------------- ---------------- -------------------------------------....----- --- ----------------...-•----•---------------.-...------------------------------- I ---------------------------------------------------------------------- --' ------- - ------- ----- -------------------------------------------------------------------•--------------------------------------------------- !i ,f�f Date -6--7 ........... FINAL INSPECTION BY:_._._:___-•--- ---------------------- "�` .L___ SAN JOAQUIN LOCAL HEALTH DISTRICT i130 South American Street 300 west Oak Proof 144 Sycamore Street 305 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California S re 9 019VISED 9-99 2M 6.61 ATLAS I