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FOR OFFICE USE: -------------------------------------------------------.- APPLICATION FOR SANITATION PERMIT Permit No. ../ .... -----'�//-o--- ---�:'- (Complete in Duplicate) Date issued ___ ------ ----- - ------ This Permit Expires 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 descrbed. This application is made in compliance with County Ordinance o. 549. s 1 JOB ADDRESS LOCATION- &.-J 7-(- Owner's Name--- -----�,/i-A-- r --------------- ---------------------------------------------Phone.................................... Address........... Contractor's Name.. ------- -------------------------------------------------- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court 23•' v'Llotel ❑ Other ❑ Number of living units: 7-__ Number of bedrooms -------- Number of baths .______ Lot size ____________________________________________________________ Water Supply: Public system a ommunity system ❑ Private ❑ Depth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ 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.) c { Sept' ank Distance from nearest well_________________Distance from foundation--------------------Material---------------------------------_--------------- I No. of compartments---------------- - -- Size--------------------------------Liquid de th----------- ---- ---------Capacity Disp I Distance from nearest well.._-________Distance from foundation�-�?__4-------Distance to nearest lot line.... 9 � ii��99 Number of lines----------`----- _________________Length of each line.._..-...---------------------Width of french. lf__:._._________--------._ Type of filter material'�� 0-0 _________Depth of filter material.._: $.`!_________Total length_.,.U--____S------------------------ Seepag Pit: Distance to nearest wellTW_______Distance from foundation__0._______---.Distance tgrnearest lot iine..��-�____. Number of pits_____i-------------- mate rial` A(______Size: Diameter-� Depth---ta�!_r..___...____.______ Cesspool- Distance from nearest well----------------- from foundation--------------------Lining material..................................... ❑ Size: Diameter--- •-•---------------------------Depth---•------------------------------------------------Liquid Capacity----------------------------gals. Priv Distance from nearest well-------------------------------------------------Distance from nearest building1 ❑ Distance to nearest lot line---------------------------------------------------------------------------------------••------------ Rerrtiodeling and/or repairing (describe :______ __' -- ------------- --------------------------•------•---------------------•----•-------------------------------------•----------------------••-•----------•-------•------------•--------..._. ------------••-•-----•••---------------------- hereby certify that I have prepared this a plication and that the work'will be done in accordance with San Joaquin County ordinances, State laws, and rules and re do of the San Joaquin Local Health District. j (Signed)-•-----------------------------•-------- ----------- ---- -- ------•----(Owner and/or Contractor) By:--------------------------------- -------------- ..-...-....----- ----------------------------------•----------•----------•-(Title)-----------------•---------------------..._..--------- (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY----------�----- ".-` ------ ---------------••----------------------- DATE.---f �f REVIEWEDBY------------------------•------------------- -- -------------------------------------------- DATE----- BUILDING PERMIT ISSUED--------------••---- •------- •---------• --;------------------------------------------------ DATE------•-,--- Alterations and/or recom dations:--------- � -��- � __..__. — --------- ------ —� t� t'="L= �-• l 1-------------------------- - - --------------------- -----------------------------------------•-------•---•----- _ ............... FINAL INSPECTION It. BY:.... -------=-- ---- Date-------` -- - --- AN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 00 West Oak.Srroot, 124 Sycamore Street 205 West 91h Strut Stockton,California Lodi,California Manteca,California Traty,California E5 9 REVISED 8.99 2M 5.62 ATLAS -