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FOR OFFICE USE: - ___ _____________ --------- APPLICATION FOR SANITATION PERMIT Permit No. ... 4 f. -� (Complete in Duplicate) (o This Permit Expires 1 Year From Date 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 Ordinance No. 549. JOB ADDRESS AND LOCATION..-:- --- � �a,errulr Cdey�-�••_ b .... . tet..__ YhW Owner's Name _--------------------- ---------------------------------------------- Phone.................................... Address �p,"_o-�-•------- ............... Contractor's Name---------•1611,27.. / Bad 1'---------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/--'Number of bedrooms ' -_. Number of baths ./..... Lot size /.6,t/ ,Xf. �...........................! Water Supply: Public system ❑ Community system �I�rivate ❑ Depth to Water Table _ c�ft. ! r Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ja0l;ardpan ❑ Previous Application Made: (if yes,date____________________] No New Construction: Yes 23-No ❑ FHA/VA: Yes Rj No ❑ l -TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted .if-public sewer is available within 200 feet.) • " Septic Tank: Distance from nearest well______--------Distance from foundation.... Material- No. p s1' Size"_M ._ -----•---Liquid depth--'� �.-_-�-Jr-----Capacity ..---.M...:....0::..------- of .-.•.-.-.-.- `Disposal Field: Distance from nearest well___, ._Distance.from fonatiZ .:.. __Distance to nearest lot line _ [dJ� Number of lines_-_'AA_!----------------------_Length of each Iine�._ ed______.__-:.--__.Width of trench---A--------.-------.........._ ype of filter material._.: �` T _ __ epth of filter material...�� _______.--Total length_../6;;fZ...........---------------- Well \� Seepage Pit: Distance to nearest _____.—"_____.Distance from foundation_./40..........Distance to nearest lot line_________________ Number of Lining mate ria lXgPGr6__.Size: Diameter__ _--------Depth.- 20�7.................. Cesspool: Distance from nearest well_________________Distance from foundation----_--.____.,.____.Lining material............___..............I....... j ❑ Size: Diameter-------------- •----•-------- --------Depth----•---------.._...--------------------------------Liquid Capacity----------................gals. Privy: Distance from nearest well_`_...____-___-'_-------------_--------___......Distance from nearest building---_______............ __......-..'.._.__... ❑ : = - - ------ --• - ---- -^"^'�Dlstance;,to nearestJ6t lane__ - - e-----' ,;;: v = -------------------------•---- ----------•------------------- Remodeling and/or repairing (describe) �� -T = ----•----------------- - . ti - ------------------------------------ ._ ______k__- - I _ ____________�-----------------------------------_...____._...______......__.._._...._.___________._________.____.....___...._______.__.__..._.......____....-........___..._._._..._...__...___._________.......-__ hereby certify that I have prepared +his!'application and that the work will be done in accordance with San Joaquin County ordinances,#State laws and rules and regula+ions of the. San Joaquin Local Health District. (Signed) j /or Contractor) } ----- - -------------------------------{Ttle1 ` (Plot plan,'showing size. of lot, location of sys. in relation to wells, buildings, etc., can be placed on reverse side). n F EPARTMENT USE ONLY APPLICATION ACCEPTED ----------------------------DATE.- ---Z=--- ----=-Z'-- -- ----------- REVIEWED BY-------------------•- '." .""�"- DATE.__... ... -- -----=... BUILDING PERMIT ISSUED --- =---------------•�-�--� -� ------------- --------- ......... DATE--------• -------------------•--- era tons and/or recommencrations___ ______ _______ -------------------__------- -------•---------------------------------------------------------------------- - .. _ --•-••------••----. ---------------•---------------------------------- ..----•--•---•. .................•-----...-------•------------.. ------- -------------------------------------------------------- ----------------------------- •-----------------------._....--- ------------------- -------------- ------------- ---------- ------------------------------------------ FINAL INSPECTION BY: Date 3 �-----------------------------------------------. -. SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street f 300 west Oak serest 124 Sycamore Street 205 West 9th Street Stockton,California ' "'^ i Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-99 2M 5-61 ATLAS