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%-.FOR.OFFICE USE: -------------------__-_____.-___--________.--_--_--- APPLICATION FOR SANITATION PERMIT Permit No. __�..v..�...3� --------------------------------------------------------- (Complete in Duplicate) --------------------------------------- This Permit Expires l Year From Date Issued Date Issued --- Application is hereby made to the San Joaquin Local Health District for a permit to c nstrt4ct and install the work herein described. This application 's made 'n complia ce wit C unty Ordinance No. 549. 3 I � AND �_ y JOB ADDRE S ANCA ION-- �� f�-----13 $ 1 -� •. Owner's Name-----.W.a7------------ - Phone --------------------------- _-----....... Address ---------- --•-•------I) �p',. w'° Q?' Contractors Name �-= ------------------------------- --• Phone---•--........•-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ..3--- Number of baths ._2,.__ Lot size •__.h. ..,, .3..l...................... Water Supply: Public system ❑ Community system ❑ Private Depth to Wafter Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0--aay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 2—New Construction: Yes t3-1No ❑ FHA/VA: Yes ❑ No 0---- TYPE OF INSTALLATION AND SPECIFICATIONS: ;(IJo sep+icy+ask�or�cesspo permitted if p�blic SB��W�� is avail bleawithi . 200 feet.) �r Septic Tank: Distance from nearest well�,4. .._._____Distance from foundation.�a..............MateriaL_ ____ ___._....................... [� No. of compartments-------Z------_----...size----3X&S:�jr---------Liquid depth_____................Capacity.___,, a? Disposal Field: Distance from nearest wel -W l-��.� Distance from foundati n..�__.._...._.Distance to nearest lot line-s ❑� Number of lines-----------------------------------Length of each ----------------- idth of trench-----------�-_`k__-___............ Type of filter material...../__.A_er__/r....Depth of filter material _-/J.............Total length______ I ___________/_ _______ Seepa�Pit: Distance to nearest well__/Pe__r_..........Distance from foundation__�S_ _____----Distance to nearest lot line___�_ __._:__ s �[] Number of pits______ __ ___ _ ___Lining materlal___ Wi __-- Size: Diameter__. �-------------Depth ---------------- Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material..................................... ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------•----•-_----gals. Priv Distance from nearest well___________________________________________ _ Y: . ---.Distance from nearest building.......................................... �• ❑ Distance to nearest lot line---------------------------------------------------------•-•-----•-•----------------------.-----•-••-----•----------------------------------- Remodelingand/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------••---------------------.----.-.-.--------.-.------------------------------------.------------.----.-.------.-------------------.--------------------.----.------------.----.------- -------------------------._-.-_-------------•-•------------•----••------------------.._-.------......------------•--------....------------•-----------------•--------------------................................. --------- I hereby certify that 1 have prepared +his app' ati and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulation t San Joaquin Local Health District. [Signed].....................:....:..... -------------= --------- ------------------------------------ •--....._.._._..._..(Owner and/or Contractor) (Plo plan, showing size'of lot; Iota ion of system in relation to wells, buildings, etc., can i placed'on reverse side]. —_ FOR DEPARTMENT USE ONLY Q i APPLICATION ACCEPTED BY------------------------------------------------------------------------------- C� DATE..--------. /r =I f------------------- iI REVIEWED BY ---•---------------- DATE---------------------•------------------------------------- i 7- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------.._. DATE--------•--•-----••----------------------------------------- E Alterations and/or recommend'ations:------------------------------------------- •---••--•-- •---------•---- ------------------•--------••--••---•-•-------•-•--.-----------•-----•-------- ..........�=Y_4_-"G/'------� -------- ��""� 1��---_�7/.< -------------------------------------------------••------•-••------ ------------------------------------------------------------- ------------------------------------------------------_....................................--•----------------------------------•------------------ ---------- ------------- ---------•................. ...........•-••----------- ------ ------ -----•---------------------------------------------------------.------------------------------------------------- r FINAL INSPECTION BY:------. �•------------ ---------,_ Date-----------------I. ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 Stockton,California Lodi,California Mantecar California Tracy,California Er 9 ttEVISEo a-59 rM 6-61 ATLAS 4� _