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FOR OFFICE USE: ---------------------------------------------------•---- -------------------______-------------------------------. APPLICATION 1=AR SANITATION PERMIT Permit No. - -----__7./?' ------------------------------- --------------- (Complete in Duplicate) ---------------- This Permit Expires 1 Year From Date Issued Date Issued ....., ........... Application is hereby made to the San Joaquin Local Healfh District for a permit to construct a"install the work herein described. This application is made in compliance with County Ordinance No. 549. r JOB ADDRESS AND LOCATION._._ el ___-_---_-• Owner's Name. , . • .teat , --------------------------------------------- Phone-----------._...- ................ Address----------....... !2�....... r�/v�+-• /"' '� Contractor's Name.... rr- -------------------------------------------------------------------------------------------------------------------- Phone....___------------------••- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court [3 Motel ❑ Other E]Number of living units: _/_____ Number of bedrooms ---- Number of baths . '.-. Lot size J.;_:t_.r _7-)•___________________........... Water Supply: Public system ❑ Community system ❑ Private ® Depth To Water Table *Q. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam NJ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No f� New Construction: Yes. ] No ❑ FHANA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__cS'b'_--._ " Distan a fromffoundation----/a'._----_.Material._ tl No. of compartments___ _________________Size �' � c .._... _ _'' Liquid depth_.. "/ ___Capaity.lA _o------ Disposal Field: Distance from nearest well rO------. Distance from foundation1_a-------------Distance to nearest to line__.... Number of lines________ �4 _ ______ Length of each line--- Width of trench._ _-_____________ - -- ------ ----------------•- Type of filter material -. -Depth of filter material-_ 9''_-_-_...__Total length___�"f �f ft'_______________ 0 Seepage Pit: Distance to nearest we ____________________Distance from foundation--------------------Distance to nearest lot line_....___.________ � ❑ Number of pits---•------------------Lining material-----------------------Size: Diameter_--------------------Depth__•----.------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation___________________ Lining material------------------------------------- F1Size: Diameter--------------------------------------Depth-----------------------•----------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well--------------------------_--------------______Distance from nearest building---------------------------------------- ❑ Distance to nearest lot line Remodelingand/or repairing (describe):-----------------------------------------------------------------------.--------------------------------------------------------------------------------- ---••-•-•-------------------------•-------------•-------------------------------------------------------------------------I-------------------------------------------------------------------------------- ----------------- ------•--••------------------•------------•-------------------- -._...----------------------------•---------••----------------------••--------------------------------------------------•---•---•----••---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and rules and re ulations of the San Joaquin Local Health District. (Signed) ----------------------------------------------------------•-------- ------(Owner and/or Contractor) By------------------------------------------ ---------- --------------------------------------------------•-----------------------(Title)------------------------------------•- ...... ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -FOR cDEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- REVIEWEDBY----------------•-----------------------•---------------------------------------------------------------------••---- ------ DATE--------------------------- BUILDINGPERMIT ISSUED.....................-------------------------------------------------------------------------------- DATE--------------------------------------------- Alterations and/or recommendations:-•------•------------------ ---------------- ---------------•-••------------------------------.-------------- --------------•••---•-------- --- -- ------------------------.-------------------------••---------------•---------------•--------------------•--••-----------------------•------ ----------------------•------------- FINAL INSPECTION BY: s1Yr1 - Date_6.7//`_4s�--------•----------------------------------------- 01 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wort Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED a-59 2M 5-62 ATLAS / tea