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FOR OFFIC U 1y/ ATION' FC}R SANITATION PERMIT Permit N0. ............... r ----------------- ---•--u --- --- F (Complete in'Duplicate) --------------------------------------_. --._.___.___.__. This Permit Expires 1 Year From Date Issued Date Issued ......1........._. � nJ r > /— !1F0_0 Application is hereby made. to the San Joaquin Local Health District for a-permit to construct and install the work herein escri ed. Thi papplication is made.in.compliant with County Ordinance 549. '• .._... --- -- ----------------- JOB ADDRESS A O ` TION. . ....................91W.- Owner's - x Owner's Name....__ ._ . .•• ------ .......... ... ..• . • ....----•-•---,y -------------- ---- --�%-------- . Phone.................................... Address-----i-------< ----------- :.,'�----- ` �' ..-.l.... .....---`. --•-•- Phone_.._.. . • _.... ContractorsName............... - -----•------- -------------------------------------------------------------------------------- -•--- Installation will serve: 'Residence [�artment House ❑ Commercial ❑ Trailer Court ❑ Motel-O—Other ❑ Number of living units::. Number of bedrooms___ Number of baths .f-_-- Lot size ..... ..................... Water Supply: Public system ❑ Community system ❑ Private [t]/IJepth 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 �A/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,! A 'c nk: Distance from nearest well---------------..Distance from foundation--------------------Material:...------------------------------------------- .. ,t� No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity..--------------------- o I R 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-----------------------Total length---------.------------._............. .. Seepage Distance to nearest well:Q1-_-_.______DistTnIcerfq,u.,,/ndation__ i_ .......Qistanc�� to nearest lot line. ------ Number of pits---- ---------------Lining mateIe---Size: Diameter_.33----------Dept h-----rS.._____•-----___-•- Cesspool: Distance from nearest well-----------------Distance from foundation_._________-...__.Lining material...------........................... ❑ Size: Diameter---•----------------------------------Depth------- --------------------------------------------Liquid Capacity-----------•----•--•--•----gals. Privy: Distance from nearest well----------------------_--------------------------Distance from nearest building------------------...................... '' ❑ Distance to nearestlot line----------------------------- ----------------------------------------------------------------------------------- --------------------------•-•------•-------------------------------------------•-= .._..------------------ Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------- ---------------•-•-•------..------------------•---.---•- -••--•----------••----•------•----------------------•---•-•-------------------------------------------------------------------------------------•-------------._... ---------------- € 1 hereby y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t aws, an4r s and re�Ilarfionshe San Joaquin Local Health District. (5igned).. Ir --•- --4wel e ,. ._. Owner and/or Contractor) ` --- ------ -------- r --------- (Plot --- �� (Plot plan, showing size of lot, location of system in relation tbuildings, etc., can be placed on reverse side). FOR DEPART ENT USE ONLY I APPLICATION ACCEPTED BY---- - ------------------ DATE---- /.- � ---------------------- fREVIEWED BY--------------------------------- -------.....-- -------------- -----•---------------------------•---•------ --------=----- DATE............................................................ BUILDINGPERMIT ISSUED-- ------------••-- ----------------------- ----------------------------------------• .............. DATE-------------------------------------------------............ Alterationsand/or recommendaticnt:--------------- ----------------------------------•-•-----------------••----------------•---•-•-•----•--•-----•----------•-----------•--•-------•---•-------- kI ...• .. . __ = ....---- ---------- - ------- -- ---- - ` a � .. � . .. . ---- -- --- ------- -----._ -.--_--- - -- ---- ................ •...................... ..... P FINAL' INSPECTION Bir__. Date... !: :Pq ................................ F, AN JOAQUIN LOCAL HEALTH DISTRICT 130 South Ainerican Street 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 YM 3.61 ATLAS - -