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FOR OFFI� USE: f APPLICATION FOR SANITATION PERMITPermit No. .....•................ ------------------- ------------------------------------ --------------------------------------------------------- :_ (Complete in Duplicate) / 7i ► This Permit Expires l Year From Date Issued Date Issued ....P.....------------ 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. JOB ADDRESS AND LOCATION �� ....................... � ��`� .. ��✓✓JJ� � / ! Owner's Name---- ............ '?!r-_ ------------------------------------------ Phone_tM-_- 59�'f� Address._ r c ------------ -- -7---------- Contractor's Name...---- e. �� : Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑3 Number of living units:-I___ Number of bedrooms . __. Number of baths __ar. Lot size ._AA3__a.c-iZ:p1------------------------- I. Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table .6.__- ft. 0Pe 7 Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam [-] Clay Loam [:I Clay [-] Adobe[� Hardpan C] Previous Application Made: {If yes,fdate--------------------) No ® New Construction: Yes ❑ No a FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic ank: Distance from nearest well_________________Distance from foundation............--------Material-_____--_________--.. ......................... . �/fS _V No. of compartments-------------------------Size-------------------------------Liquid depth-- --------- --------Capacity............--- D•+sposa! Field: Distance from nearest well------------------Distance from foundation---____•_______.....Distance to nearest lot line................. ® Number of lines-------------/- ------------ Length of each line------Mo-----------------Width of trench,__,36 --.- .--...... --.... ' Type of filter material_z� ---.Depth of filter material.....a _________Total length----------1� ._._.____-__ t Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----_---------- 1-1 Number of pits----•------•----------Lining material-----------------------Size. Diameter........................Depth................................. 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 nearest lot line---------------------------------------•------------------------••-•----------------------------------------------------------_---_-----•--- Rem deling and/or repair ----�--'.vs'---- -------------- - u��d-c�4 .2 •cam .�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 Joaquin Local Health District. � 'f __________________________ Owner and/or Contractor {Signed)---------- ---� - --#1iocaff6h _._. ..---------- --- ...-------- - --�- -- ------•------------ ..._ .{ / ) B • -----------------------------------------------•----------------------.Title (Plot plan, showing size of lot, system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ? "-—----------------------------- DATE �1' -------------------------------- - -------------------------- REVIEWEDBY------------------------------ ------------------------- -- -- ---------------------------------- ----------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----------------------------------------------------------------..-------------------- ---------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------_ --------------------------------------••----------------••--------------------•----•-------••-•--•-------•----------------------------------------- FINAL INSPECTION BY:........ ---------------- Date------------- - � --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California e� EB 9 RBVISEo 8-89 LM S-dl ATLAS