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FOR OFFICE USE: -------------- -- ------------------- ---------- --------------------------------"------ "-- APPLICATION FOR SANITATION PERMIT Permit No. _... .. � - --- (Complete in Duplicate) . This Permit Expires 1 Year From Dafie Issued Date Issued 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 Ordin No_ 4 . JOB ADDRESS AND - - - ---------- ----------•----Owner's Name -----------------------------------................ --------------- •...... -- ------ ----- ......... .•-- •- Address.... Phone ...... -•--- . ...-•--- Contractor's Name--------- ------------------------------------------•----------------•------•-----------•------••------------ --- --- -- ---- ----------- --- Installation will serve: Residence 'A -----•------••-----•••-__".__.-------. --- Phone................................. partment House ❑ Comrs�erciel ❑ Trailer Court Number of living units: ._"_ Number of bedrooms E] Motell ❑ Other ❑ J---- Number of baths /--" Lot size ArXA " Water Supply: Publics stem Y ❑ Community system "•"-•--"-•--••'""-•""--'-- O Water Cheracter of soil to a depth.of 3 feet: Sand ❑ Gravel ❑PriSand[I Depth rClay Laamable��!ft. Previous Application Made: (If yes,date_____ _ ._--__ _".____ ❑ Y ❑ Adobe�ardpan D) No ❑ New Construction: Yes ❑ No ❑ FHANA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: '' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we l �� Dist m o��ation_.-��.""-•_Mat --------------- �� No. of compartments_.--- --_-- -•- - Siz _ --•-•-•------� Liquid depth_ �� ____ ----Capacity Disposal Field: Distance from nearesf,well-_____-.___ i Distance from foundation•_ _- i l Number of lines.__.__ ��'---•-----Distance to nearest lo} line_.".-_••_ --•--- /---_ ___-.__ Length of each line_Z4&_ VV;dth of trench._Z•"_ ""_" . Type of filter material- Depth of filter material__ � i ---•""""-""------ ------ .'_Total length_-- -2._„-" Seepage Pit: Distance to nearest well------- -77!7�"""_"Distance f om { undation._ �1,e�......D'st rife to nearest lot li e_. ---- i � Number of pits------�"""-""_""Lining material_ ---.Size: Diameter--- ----------Depth--.2�'---------------- Distance Cesspool: from nearest well------ ❑El from foundation.-_-_.--"""__ Size: Diameter------------------ "" ------Lining material_.----------------- """ --------------Depth-------• --------- Priv --------Liquid Capacity- --------------------------98,1.s. Y= Distance from nearest well__-___.__-___. ................... ❑ Distance to nearest lot line- Distance from nearest buildin---------------------- 9--------------------------.------------„. Remodeling and/or repairing (describe)------- � ---- 4 -•---•-------•---•------------------- �r%K { ---- - - - -- ------------------- -- . -- --------------------•---•------ -.....•----------------------------•-------------------•-----------------------------•--------•----------•------------•-•--------•--------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules nd regulations of the San Joaquin Local Health District. (Signed)-------- --------------- ---- ---------- -------- ----•--•- -- BY:--------•--..._-•---•------•------------------------ � r Contract t -- r a (Title) - Contractor) (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ REVIEWED BY----- ------------- DATE_.: . BUILDING PERMIT ISSUED.. -------------- DATE~------------ Alt rations and/or re mendatioAZ; ----------------------- --•-- ----- ----- ------------•--------•----- -------------- -•---..........-------------- ---------- - FINAL INSPECTION BY-../ .... ... Date ------- -. . SAN J QUIN LO AL HEALTH DISTRICT 130 South American Street 300 1N Oak Srreet 124 Sycamore Stmt Stockton,California Lodi,California 305 West 9th Strobl ES 9 REVISED 8.59 2M 5-62 ATLAS Manteca,California r Tracy,California