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^ R oF�F/I E U Y _- ��-- 6r=_:____.__. APPLICATION FOR SANITATION PERMIT Permit No. Z _ ---------- ------ (Complete in Duplicate) %` Date Issued ---------------- ----------------------------------- --- This Permit Ex Ives 1 Year From 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.Up. 549. JOB ADDRESS AND LOCATION•_----v Owner's Name... ----------- Phone------------------_----•--------- Address---••...................... -- j .... ----- Contractor's Name._'= _.--.�1�- _ ®J!i - Phone=......... � ----------------- Installation will serve: Residence Z`f,pa ent House ❑ Commercial ❑ Trailer Court ❑ Mo#el ❑ Other ❑ Number of living units: ..___ Number of bedrooms Number of baths _`.-. Lot size ..._.. i Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 102V ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑. .Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobepkHardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ `�' TYPE OF INSTALLATION AND SPECIFICATIONS: "No septic tank or cesspool permitted if public sewer is available within 200 feet.) is 1 Distance from nearest well_________________Distance from foundation------------------..Material_______.-.__________....___..........._.......... No. of compartments------- -•----------------Size-------------------------------Liquid dept------------- ------------Capacity........- .... i osal�FF, �Id Distance from nearest well_k"�£�1E.�'__Distance from foundation-----Z�__ _.Distance to nearest lot line.. Q. Number of lines______---/_ ______________ _--Length of each line___ a. or __-_ Width of trench... _�.°!___..._______--.. Type of filter material. _. _ -_Depth of filter material...-C _ ----- To#al length_____ _-4 ..__�__________________ l t Seepage Pit: Distance to nearest well---WY14-------Distant om foundation. f r � .. (. _ ` �-•_�.---------Distance t0 nearest IOr line---- "1S Number of pits____i----------------Lining maferial_ v?t _--_-Size: Diameter__. / -- --01 -Depth---..G j---------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter------ ------ -----------------------Depth---------- ------------------1--- ----------------Liquid Capacity------• gals.t..,r ,-. Privy: Distance'from-nearest:well_:___-____-____-_::___`_._ _ ':_A __r.Distance from nearest building I° -`- g------------•-•-•----------------------•-- ❑ Distance to nearest lot line----------- Remodeling and/or repairing (describe):----------------------------------- ------ ------------ --•--• ------.---- -•.••-----•---••---------------------•--••--------------------------•--•-•---------------------- • •----------------- -- -•------= --- -.. - -- -.- - - -------.- -------------------------------------•-------------------------•---------------------------- - ---- - ---• •-- - • c �__. = ------------------------------------------------- - ----------------•------------------------ ------ 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 and regulations of the San Joe in Local Health District. (Signed)•_-- -.�L -_ � '7 _ ._... -.r- -�1 a____.__ -.--/ -- --�. Contractor) By:_-----------------•-----------•------------...-------.....-----------••-•------- ---- - --- -------------------------------------- ...................... . (Plot plan, showing size of lot, location of system in relati o wells, 6uildincOletc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_: ._ -------------------------- --------•----------------- REVIEWED BYDATE f `L ------L - ---------------------- .. ---------•- �----------------------------------------------------------------------------- DATE................. .... BUILDING PERMIT ISSUED------------------------------------------------ --------•--------------••-•--•-----------------•--•-- DATE.-----...... Arations red/or recommendations::.----------------------------------------------------------------------------------------------•••-----------•-------...-------------•----------•----••------ e;--• --- ----- •-•-------------------- ----- :... -•---------------------------------------------------------------------.... ----------------------------------------------------•--------------------------.--------------------------••-•-•-----..._.......-------- .......................---------------------- ------------- I FINAL INSPECTION BY:.--- ---- Date r : _ ---Z------•- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California E8 4 REVISED 8.59 ZM B-61 ATLAS