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FOROFFICE USE: ----------------------------�-------------------------- `/ ..5_.�_r_G_�-�,- __ APPLICATION FOR SANITATION PERMIT Permit No. ,7 . .�--- --------------G - (Complete in Duplicate) / `} Date Issued . �----•-� --- f t.---. This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the rk herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__iJ r= .... ------------- --------------- .............................----------------�f---_--•-•--_------- Owner's Name-- •-- U . ,. - - ----------------- Phone . .---••. ----••-•-------- _� Address----------- - f Contractor's Name-__ �At ... i -. dam �A ► Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trail ourt ❑ Motel 4 Other❑ Number of living units: ___j___ Number of bedrooms Y-_.. Number of baths 46WIt size ______� ..................... Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table C'pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ bbe ardpan ❑ Previous Application Made: (If yes,date--------------------1 No ❑ New Construction: Yes ❑ No Rr FHA/VA: Yes ❑ No ❑ TY INSTALLATION AND SPECIFICATIONS: (No se it or cesspool permitted if public sewer is available within 200 feet.) ept• nk: Distance from nearest well________________Distance from foundation....................Material................................................. of compartments--------------------------Size_------------------------------Liquid depth___------------------__..Capacity......-................ al ield: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line..._._:---___--_. Number of lines------------------------------- --Length of each line-------•--------•-_------.._.Width of french----------------------------------- -Type of filter material_____________________ __Depth of filter material-------------------- tal length----------________________........ ...�..� Seepage Pit: Distance to nearest well__ _Distance from f undation_... .�..___.Distan e to nearest lot line___.!______ Number of pits....__-------------Lining material_gOCA____Size. Diameter. �' ._*___.Depth____•r —----------- G Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material F----------------------___________-_ C ❑ Size: Diameter--------------------------------------Depth_-------------------------------------------------Liquid Capacity--------------------_--_gals. (' Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ `(,-1 ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------••-------------•--••--••------------------------------- I � - Remodeling and/or repairing (describe):-------------------- ----------•-- ----• --- .... --.----••---------•--------- -----•--•..............•---------------------------__..........------------------------ J ---- --•------ ---- ----- --. .s --_ - •-----------------------------------•- �'l l �----�-----___- ---•�'�,Z_I-��--- ---- -------------------------------------------------- --/�- ------------------------------------------------------------------------- � -------•----•-------- I hereby certify have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State la , an ules and regulati ns of the San JaMuin Local Fjfi aljth District. (Signed). -�--- --�--- -----� '------------•------- Contractor) V. t (Piot plan, showing size of lot, location of system in rel to wells, building etc., an be placed on reverse side). I FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -� ------------------------------------------ DATE----• .`�_ _ " 7 REVIEWEDBY----------------------------------------------- --------------------- ---- - •---- DATE_-----••--•------------------ - - BUILDINGPERMIT ISSUED-------------------------------------------------------------–......-------------------------------- DATE--------------------------------------------- ............... /"t erations and/ r recommendations: _______________________ ---- -- ------- --- ----------------------------- -----•-------------------------------------------------•--•-•-•---------------------------------------------------------------- ------------------------------------- ----- - -----••------ --- ------ ------------------------------------------------------------------------------------ ------•--•--•---------•------------------------------- FINAL INSPECTION BY:.......-.- _ ---- -- —---- '--- -- ---~-- - - -- - - ---------------------------------- 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 REVISED 6-99 RM 5-41 ATLAS