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FOR oFFl7��u : f`------ ----- - ---- - - ----------�-< -.=-•'--:"-------------'1�f -- ) 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 per it to construct and install the work herein described.- This application is made in compliance with County Ordinance No. 54 . 1 SCUNP JOB ADDRESS AND LO TION---.... --- --�- "Y�1_± .1... ..............• - ....... Owner's Name......I------ _� - -------- ........--••-•- -----------------------------••----. ..--•--- Phone--•---- � !1l1►�?�Otl r` n& �----... s --- --------------•--•-••------- ---- ---------------- .............. .......-.............. 4 ----•--••--•-- . ` Phone../Contractor's NaipC�z Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other Number of living units: ...... Number of bedrooms • _ Number of baths......... __....Lot size -------.___54..X-400................ Water Supply: Public system/R Community system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ Previous Application Made: (If yes,datel _ 1.�` l-} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -4r-10(p ` -`� ✓ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well_________________Distance from foundation.................._.Material.................................................. r_ �5 n� No. of compartments .- 'L..Size________ ____ _______ ______Li uid depth Capacity tY ...� ------•- Disposal Field: ;Distance from nears s well __ _ -Distance from foundation__°��.__ ....Distance to nearest to line....�1 .�... Number of lines-___ - Length 'of each line------- -• Width of trench._____ J { ] ^, --- G Type of filter material._ Q 4 r04Depfh�af filter`ma#erial.__ .�? . -------Total length-------------- Seepage it: -.Distance to nearest well___`_=______::::Distance from foundation ....n :._=Distance to nearest lot line_________________ ` 11�istance -Number of pits----------------------Lining material_-----..-.------__.---Size:,Diameter.- t..........Depth.---••-•-:-------.._..----.--_--- -� PL ��15t r (��Cesspool: from nearest well-----------------Distance from foundation!._:_._________.....Lining materia .................................... U) ❑ Size: Diameter--------------------------------------Depth...--------- � - _----Li Liquid Capacity..........._. ` gals. Privy: Distance from nearest well-----------------------_______________________-^D�"stance from_neerest building_..:....___._______.___._................ ❑ Distance to nearest lot line---------------------------------•------ r` •------- --- ---_'- - ?.. � ---•------- Remodeling and/or repairing (describe):___ "--..11p_ 'E��n_S--------- .................. --------------------------------------------- ----------------------- f �" a. t C --------------------------------------•--•---------•-•------•-------------..-...-•---•-.............._....__--------- -------------------------------------------•-.......•------------------------•----•------------------- I hereby certify that I have prepared thi application and-+hat-the work will be done-in-accordance-with San Joaquin County ordinances, State laws, and rules and regul ons of +he Sa Joa in Local Health Distr ; (Signed).•-•-X..:77��__' C; -- [ end/or Contractor) . .... BY: =-------------------------------------- -------•-- •...------------------------------(Title)------------------------------------- -------- --------- ------- 1 (Plot plan, showing size. of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY-------------------------------------------------------- ------! P _C/ DATE------------ REVIEWED BY------------- 1 -i -� -------- DATE PERMITISSUED----------------------------------------------.-------------------------------------------------------.:DATE-----------.•---•-------------------------- Alterations and/or recommendations:._ .8._—. ` _' __. s� n_ � - �� •-_ FINAL INSPECTION BY:... �? - �_ Date----------- ------------------ ---------- S } SAN�InAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street , 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9 9 REVISEO B-59 2M 8-61 ATLAS ,i4