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----------------- --------- St -.._ _______________________________ APPLICATION FOR SANITATION PERMIT Permit No. .. -�_.____.... -------------------------------------------------•---- (Complete in Duplicate) Dote 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 described. This application is made in compliance with County Ordinance No. 549. E _ 7 , JOB ADDRESS A LOC ON.. /] ,�___ ""_r.�_k.lfl(a __-Q.c_��I1 , Owners Na �Ir0 �5.-� ...- --. Phonej. ---��. -- Address. == =C� --------------- - ........................... _f ------•-•-•- ...... Contractor's Name-: -_.____ ' ._ e ....... .................. Phon Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._..__. Number of bedrooms _. -.• NumbeZh the ..I. Lot size -__.1L7__@-�- I ..-.Z-b0 . -L6?-r..____. Water Supply: Public system ❑ Community system [I Private to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loa Clay Adobe Hardpan P ❑ ❑ Y ❑ Y Y ❑ ❑ pf ❑ 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 blit sewer is available within 200 feet.) r �}- `� f fWa ` ' ------- r Septic Tank: Distance from nearest w II-_. Q ..Distan fQrF founf��tion•.... .........•....Mat rlal.i__-_.__ 4 ! --..-:. ___..._- XNo. of compartments---- fSize_ 6. V---3b.,...Liqu id dept- -------------Capacity.__ Q a Disposal Field: Distance from nearest well- -___Distance fromoundatio ... .>1�i ....Distance to nearest lot lin _A Number of lines- A4. ___ Length of each line__________._ #..Width of trench___�...4x�`... .......... Type of filter mate 9:___ .Depth of filter material______ Total length.____-- Q___-----------......... h Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------.Distance to nearest lot line----------------- s y ❑ Number of pits----------------------Lining material----------_------------Size: Diameter------------------------Depth_-_--_-_-.-______-_ t Cesspool: Distance from nearest well--------_--------Distance from foundation--------------------Lining material......................... ------------ n __________❑ Size: Diameter---------------------------------------Depth--••-------• ---..........------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____-_____--._-.--_----•-•--__-.___-..-__. ❑ Distance to nearest lot line------------••-----•--------------------------------------------------------••---•------... l Remodeling and/or repairing (describe)_________________ _ ft = --•---•-••----------•-------•• -- --------------------------------- ----- -- - ;-- - -----••-- ............. f --- r ...l�-�..--------- -------- -- •-•-- - ------------- ------- - ------ ------ I hereby certify that I have prepari this application and that the work wil be done in accordance with San Joaquin County,_ ordinances, State law and rules and regulations of the San Joaquin Local Health District. 'rlF (Signed).. ------ --- Contractor BY= = (Title) ---------------------------------- (Plot plan, showing size of lot, location of system in relation to ells, buildings, et can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.-- -- � �� ----------- • ---------------- DATE----------------2 1---�--Afn REVIEWEDBY---------------•-----------•-- ---------------------------------------------------------------- DATE---------._..---------------------------------••------ BUILDINGPERMIT ISSUED------...--•---•--------------------------- -------------------------------------------------------- DATE---------------------------------------------••.............. Alterations and/or recommendations---------------- ------ ----------------- ---- ------------------••------••-----------------•----•---------•-----------------..._.__---•-------------------- ................. --------•---------------------------------------------------------------------------• -•--------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------- -------------....................------------------------------------------------------------------------- ------------------------------------------- -------------------------------------•-•----------------------------- ................ - ----------------------------------------------------------------------------------------------._..--------..-..--•---------------------------- FINAL INSPECTION $Y:.- 1 –�------ --------------------- Dete z.7/ — SAN JOAQUIN LOCAL HEALTH DISTRICT + 130 South American Street 300 West Oak Street 124 Sycamore Street '"* s ^2.05 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 0.69 8M 8.61 ATLAS p�,w