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FOR OFFICE USE: I ------------------------- ------------------------------- ------------------ -------------------------------- 'T IM.... APPLICATION FOR SANITATION PERMIT Permit No. _.2�rf�.. 9 - ��M (Complete in Duplicate) ------------------------------------------��--�------;:--- This Permit Ex ares 1 Year From Date Issued - issued _... Application is hereby made'.o the San Joaquin Local Health District for a permit to construct and install the work here escrbed. This appli22S is made in made'. Bance wit County Ordinance No. 549. 'a lIh lo �JOB ADD C .TION` ¢-------:-t' ---- C/U . Owner's Name...... '�� P/ ----------- - ------ Ph e....... Address Contractor's Name.----- i —fit--/---------- -- --- ------------- ---- -------------•--•--------------- Phone----....1 ......................... t Installation will serve: Residence Apartment House ❑ Commercial ❑. Trailer Court ❑ Motel ❑ Other'❑ Water Supply; Publicgs st�r�r: .f•-- o r -- � 1--- Lot size _- . Number of living units: .-- . Number of bedrooms _�Number of oaths __ y ❑ 'Community system ❑ Depth To Water Table'--. :-- ft. IK Character of soil to a depth!,of 3-feet: Sand E] Gravel ❑ Sandy Loam-[]� Clay Loam eclay ❑ , Adobes❑ Hardpan ❑ Previous Application Made:��(If yes,date--------------- -I No.❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes El El TYPE OF INSTALLATION ' ND SPECIFICATIONS: 1 " (No septic tank or,cesspool permitted if public sewer is available within.200 feet.) Septic Tank: Distance:from nearest wail-----------------Distance from foundation------------------ Material------------------------......................... ❑ No. of compartments Size.-.. ` Ciquid depth-------------------------Capacity-------•----•---------- Dispose geld: Distance,from nearest well----r��----.-Distance from-foundation_--- /.4----- to nearest lot line.-_6�---_.__. Number%f lines ------ �r l ---.----.---_ Length of each line....-_-�-�---------- -----Width of trench---�,..------- r f� 1 Type of material..--.--j----jr--Depth of filter material------/,�------_--Total length-..-.__-._-_4!-..--.---_•--.-.•.._...-- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line.................F ElNumber%f pits----------------------Lining material-----------------------Size: Diameter-------------------------Dept h---------•----------------------- Cesspool: Distance;;from nearest well-----------------Distance frornfoundation--------------------Lining material__----------_----_.--------_-------- ❑ Size: Diameter------ -------------------------------Depth----------------------- ----------------------.._Liquid Capacity-----------...-------------gals. Privy: Distance,from nearest well------------------------------/-----------------Distance from nearest building------------------------------------------ Distance*to nearest lot line-------------------------- Ri� -.pn /or repairing (describe)---------------------------------- --------•--•------------------------- --•-----------------------•---•-------------- '11---------• - Ir ---------------------------------------------------------- ----••-•-------•---------------------------•-- 11-------------------------- 11 ------- -------------------------------------------------;-:-----------•---------------- --------------•---__ -•--•---------------------.-....------------------------------------------------------ ---------------------------- + I hereby certify that�I Have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stateallawsd lules and regulations of the San Joaquin Local Health District. (Signed) _. = ------------•------------------------�e.�- -- �1d/or Contractor),,tip == ----- -------------------- -- -------•-------------------------(Title)--------•---•-------------------------------------------------- (Plot plan, showing size of loll location of system in relatiV to wells, buildings, etc., can be placed on reverse side). t '�f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED_'9Y ---------------•----------------------- DATE _e-�_��-G REVIEWEDBY ---------------------- ------------- ------ DATE---•-.----------- ------------ ---- - --------- rBUILDING PERMIT ISSUEDAII -----------------------------------------------------------------------------------------•---- DA•TE.-------------------•--------------------- ..-.. �} Alterations and/or recommendations--------------------------- N • d f --------------------------------------------- '1-------.-.---------------------------- - t -• d FINAL fNSPECTION r BY::�✓_"'' _--------------- Date �1 ��'��°- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stroll 124 Sycamore Street 205 West 41h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED a-59 2M 5.62 ATLAS