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---------------------- ------ ----------------------------------- -- --------. % ..........................._._.__.__..__..-__._______.. APPLICATION FnR 5ANITATION zrtRMIT Permit No. .. ... ....... ------------------------------------------------------- (Complete in Duplicate) / This Permit Ex ires 1 Year From Date Issued Date Issued ._...... .Z/ Application is hereby made to the Scan Joaquin Local'Health District for a permit to construct and instal! ! e work herein de rbed: This application is made in tom isce with County Ordinance No. 549. fa 'lam y _ '.i. yq: JOB ADDRESS LC IOTI � /y _ .. . . .----- - ... Owner's Nam -_ ----------• --- ------- ----- -- --- --- .._ _ . Phone- ----------------------------•--- Address r•J��? ----------- l!� Contractor's Na _ Phon . . ................... ----------------•----------•-••---•--------- Z Installation will serve: Residence ❑ Apartment House-❑' Commercial ❑ Trai r u Motel ❑ Other / Number of living units: ________ Number of bedrooms -------- Number of E,aths size .. •--------------------------------------- � Water Supply: Public system ❑ Community system ❑ PrivateDepth'to WetWTtsble.� ft: � Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy loam E] Clay Loam El Clay C] Adobe❑ Hardpan U Previous Application Made: (If yes,date--------------------) No New Construction: Yes [�lo ❑ FHA/VA: Yes ❑ No 'S" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2QQ feet.) —SeDistance, r from nearest well__,r_0'____.Distance fro _found tion_ --�-•-- ptic T k: Dio.stance compartments___----..--tZ---- -...Size.. �A___. ?...:__.Liquid depth_._.____�-/__r___..--.-Capacifiy. . Disposal F Distance from riesW+ wL Distance from foundation-_. _ _____.Distance to nearest Int line• __..-.Number of lines_ __ _ _ _t�" Len th of each line__ ` ` -__.Width of trench.___ ---Q....................... Type of filter materia _---- c __Depth of filter material.._./� --____Total length----3-Qe_.. . .. Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot lin _________------ ❑ Number of pits:.-------- ----------Lining material-----------------------Size: Diameter-.----------------------Depth................................. Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material_-___...___.._.________-- 4 ❑ ; Size'Diameter------------------------------------Depth---------------------------------------------------Liquid Capacity-----------------..........gals. r N $ Privy: Distance from nearest well_______________________ ______ _Distance from nearest building ______..._.___-.- Distence-to nearest-lot line---------- " — t i Remodeling and/or repairing (describe)------------------------ -----------------------------------------------------I.•---r---•-------........---•-----•-----•----------•-----•---.......... -------••----••--••----------•--------•------------- --------------------------------------•-----..---------------------------------------- ------•---------------•-•--------•----•------------------------ ti t --••----_---------------------------------------------------------------------------------------------------------------- ._.. ---------------------•-••----------------------------•------•------------------------------------------------•-----------•--•-•------•------••--•----.....-----------•------------------------------------ I hereby ce . that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St ws, and r sand regul ons of the San Joaquin Local Heq�th Distr'ct. . -C (signed) .:r ;; (� %! rear and/or Contractor) r --------------------------- - - -- -- - T'itle Y� ) - -• ... ._/---------------------------------------- (Plot ---------------- -- ----------- (Plot plan, showing size of lot, location of system i relation to wells, buildi , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ` ------------- --••---•----------------- -------------- DATE---$ -f y------------------- REVIEWEDBY------------------------------------------------------------------------------------•-----•-•-------------------------------- DATE BUILDING PERMIT..ISSUED....i•-•------------------------------------------------------------------------------------------- DATE_ Alterations and/or recommendations-------------------------------------- -----------------------------•-•-••----•--------------------------------------------•-•-------------------- t FINAL INSPECTION 0 ----------------------- Date---- -- -•--•------------------ SAN JOAQUIN 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 ES 9 REWSED 8.59 2M 5-61 ATLAS