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FOR OFFICE USE: -------------------- ------- _._-------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. �_` ` .. ....... ------- ---------- ---------------------------------=--- (Complete in Duplicate) ( z5. Date Issued ------------------------------------------ li This Permit Expires 1 Year From Date I sued Application is hereby made`.to the San Joaquin Local.Health District for a permit to construct an i�tall the work herein described. This application is made in complian with County Ordinance No. 54 i-1, z l ,v�..zoic �� ; • 6"o 54 JOB ADDRESS ATION. :_©set - a--- ... Owner's Name ILI .ti................. -- ------- -- ------------- Phone.................................... Address.................. -------- ------------------------------••------.----------------•---•-------------• ----- Contractor's Name..............K.............................. -•---••-----------•------------------ •----•--•- --- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ____ Number of bedrooms __/-- Number of baths j._ Lot size .... _ZsX---4__________.....______............... Water Su Publics stem Community system Private Depth to Water Table&_& ft. PPIY� YY Y ❑ ❑ P Character of soil to a depth o?3(ifeet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 10 Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made:; (If yes,date--------------------1 No Ug-1 New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ C TYPE OF INSTALLATION AND SPECIFICATIONS: I ( ( o septic tank or cesspool permitted if public sewer is available within 200 feet.) is T nk:' Distance from nearest well-----------------Distance from foundation-----.-_..__-_-____.Material!_'__________.__.__...._____..._____...._....... NoT, of compartments-----------I_____-. _._.Size--------------------------------Liquid depth-------.------- Capacity....................... is osal F' d: • Distance from nears we€I 'Distance f"r"dm foundation.. is#ance to nearest lot line____..__. Number:of lines___________ __I ` __._{Length of each line____ _s.5�__�__ 4t__.Width of trench______(,_ ___ W+a Type of filter matenal..._ t_ �Oek—Depth of filter material..__ -------Total length.._.�� I Seepage Pit: bistance to.nearest well_____________________Distance from foundation__..._..........__..Distance to nearest lot line___._.__...__ ] F E] Number of pits---:-'----------------Lining material----------------------- Diameter----------- Depth----•---------------•------------ 'f Rye i iCesspool: Distance from nearest _Di well________________ stance from foundation.-_-______.________lining material------------------------------------- Size: Diameter-------------- ---- De th----•------------------_---_------------------_---__Li upty_...._....--•----•---- id Capacity ---...gals. Y' Distance.from,nearest,well_._-_ f -�------ ------------- - ------Distance from neares ,EPriv -_--_-;_- • qt buildin ------------------------------------ ❑ -"� �^~ Distance to nearest lot line_—------` "". ___'• '_"�_�"_�`:"_ __ ------------------------------------------------------- I€ r Remodeling and/or repairing (describe):------------------------------------------------------------------------------ ..... ........••-•--••.................................. I I R + ' t t r 1 t ------•-------------•--- -- i i i ----------h`a've-prepared this application and that the-work will-be-done it,accordance with San Joaquin County ordinances, at aws, and.r es and ulations of +he San Joaquin Local Health District. i [Signed]____-- _-- ---------------- s --- wnar and/or Contractor) By:...............................------------- - --•---- ------------------------(Title)---- -''-f (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., canbe placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDIBY------------------- - - ------------------------------------------------------ DATE----- - - = REVIEWEDBY------------------- ------------------------- ------ - - ----------------------------------------------------------------- DATE---•------_----------------------------------••------•------ BUILDING PERMIT ISSUED----------------------------- ------ -- _ - -...._..t.--.-.--.--.--.----- DATE--------------------- Alterations and/or recom enda+ions:-------,---- --.---- P�----- ---- --------------------- ----,------ ---- ------------------------------------------ - ` �� ------ - -- --------------- - !i ------------ II FINAL INSPECTION BY �� 1 � . ------•---------------- Date ------------------------•r ------- - -------- ----............. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amertcan Street 300 West Oak Street t i 44 Sycamore Street 205 West 91h Street K Stockton,California .I Lodi,California Manteca,California Tracy,California E6^0'REVISED 8-89 2M 5-61 ATLAS II Il ', II