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rUKUrrlLt Ubt: 1 ---- .. r 1 dd �_-____-____ APPLICATION FOR SANITATION PERMIT Permit No. __ ... v , (Complete in'Duplicate) ------ This Permit Ex ires 1 Year From Date Issued Date Issued :7......_.l_°-°_- 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,Je JOB ADDRESS AND I n7ATION !?.... ---- ---- ------- = Owner's Name ----•-•• ;.. Phone Address-• ,. - a Contractor's Name..._.. , X� �--- Phone-GP---1Z Ins+allation will serve: Residence rtment House � [��a ,,❑.,aCommercial_❑_,Trailer_Court;,❑ Motel ❑ Other ❑ Number of living units: _ Number of bedrooms cam-___ Number of baths-.2 _ Lot;siz ___ , -/ - -. d--�---------------- Water Supply: Public system ❑ Community,system ❑ Private [ Depth to Water Tablis- ft. Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date-----------------r_.) No ❑ New Construction: Yes ❑ No P?- FHA/VA. Yes ❑ No ❑ TYPE OF'INSTALLATION AND SPECIFICATIONS: .4 1 i 6 *ti o septic tank or cesspool permitted'if public sewer is available within 200 feet.) i I nk• Distance from nearest well_________________Distance from foundation-_-_---_--__-_!---.Material........................................... ....... No. of compartments-------------------- -----Size--------------------------------Liquid dept_-- , -----------------••----Capacity------..........`..... Dis osal geld: Distance from nearest well-a]0_-___.__.Distance from foundation..,1.Q______:__-Distance to nearest lot line.... ......... pNumber of lines------- -----------______ �� --------Length of each line-------'$;eV_____.-�;---..Width of trench----�.�--._.._.._._•._...._- Type of filter mate rial._f.i�-------------__Depth of filter material------/--$_ ___':Total length________________60--------- ........ Seepage Pit: Distance to nearest well___7S_.........*Distance.nm foundation___ -Q....._ __ .QC _ ._ -.Distancgto nearest lot line.... ......... - [� Number of pits-------1------------Lining material_ - Size: Diameter___-:. � \� Cesspool: Distance from nearest well----------------_Distance from foundation--____--�Lining material....------------._.....__.______-_---- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity.......•--------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------....__....................... 1771 Distance to nearest lot line_' -- -----------••--••----------------------•------------...---....-----.._..--------••-•---...-----••--•---•----•-----._...------------- i Remodeling and/or repairing (descr'be):--------=------------------•- •------ -----------------•--•------------------------•----•---•-------....---------------••---•••--•-••---.._...- 9 .....................•-•----_---_____........______._._.___-_-___--________.........._________••_-________________.....______-______•-.___-_____..___...._.._____-_-_____.--______.___..._..____---_--________........._._.-_. i ----------- __________ ---------------___________________ _____ ______________________________________________•__________________.____________-_-___..-___..._____._________-______________.__ I hereb certify at I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, t e s, and rul and re tions of the San'Joaquin Local Health District. i • (Signed) '' --------------------------------------------------- ---------------------------------------•--------- Owner and/or Contractor) By:...................... '----- -------------•-•--•---------=-------•------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). OR DEWTMENJ USE ONLY I' APPLICATION ACCEPTED BY---- ----------------- DATE_...----�--�,�----"! -�------------------ - ------------ - REVIEWEDBY--------------------------------- ----•----•---------------------------------------------------------•--------------------- DATE---------------•----._.... BUILDING PERMIT ISSUED-------- ••. -- -- ----- - -----•-_-.-.9D8AT--E----x-�-----------1----5-•------------ ---- ---------- Atteratio and/or eco mend ations:. aW -- --. . _ ------------------------------------•---- --------------------------•---.-----------------------•-------•----•-------------------------••-----------------------------------------•--•-•--------------------------------------....-------•-------------•--------------- ------------------------ ----------------------------------------------- d ------------------ ------ ----------------------------•------------------------ ---- Date FINAL INSPECTION BY / Ccs f -- SAN JOAQUIN LOCAL HEALTH DISTRICT a 130 South American Street 3Q0 West Oak Street 174 Sycamore Street 705 West 9th Street # i Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 21A 6.61 ATLAS 'moi