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FOR OFFICE USE: � --------------------- ---------------•------ " No. C' _ APPLICATION FOR SANITATION PERMIT Permit ................ �-�_ (Complete in Duplicate) / ---_----_--------------------____._..__.__..__--------- This Permit Expires 1 Year From Date Issued Date Issued ............ F? 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 compliants w'th County Ordinance No. 549. Z_f g` /�� -44 CA ,,,,,,application v&1• F,q..t 2a a. S' `0. I/ _. JOB ADDRESS AND' OCATION----- --- --- ------------ -- , l- p -------- --------- Owner's Name .- ------.•.-.-.•-----_-- -----• ---------- Phone-----•--------••------------------- Address -- - ------------ --------------------•--------------------•------------------•--•--------•-------•----•-- .. Contractor's Name..---- -.-•-- -------- ---- ----- -� --------- Phone ... s Installation will serve: Residence Apar#ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑. Number of living units: ___t+__-- umber of bedrooms 3__kNumber of baths _ Lot size �............... v ' Water Supply: Public system [I Community system ❑ Private X Depth to Water Table .------- ft. : Character of so%] to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loa Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date____________________) No New Construction: Y1 No ❑ FHA/VA: 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_1.¢*Distant from foundation_!__t�_______-Materi`I i ______. ._ ------ r' - .. , / T t [Lrp�1J� No. of compartments----- /----- -------Size__ /0.X---C.-Liquid d=h_..-•-----__ _ ..�-Capacifiy.-�.'�r.l�=G`e._.; Dispeial Field: Distance from near ��-.. t well Distance from foundation._.. .....Distance to nearest lot line....�.t_..�., Number of lines___ _...._ Length of each line8 ±_-_� _ - Wfidth of trench__ ---•� 00 Type of filter material -__Depth of filter material_1.9t¢_____________Total length.'; ?.-. ." --- ------------- �Q Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_______._-_-___._ Q. [] Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth-_-_---------------.-----------•- Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material•__-_.-..--________......______-_.--� ls i .❑- -. Size: Diameter.. ---=-----•-------------------------Depth----------------------••------------------r.---Liquid_Capacity.-----------•----------_---•9a Distance from st i Privy: Distance to Bares#slot line l ---------------------------------------------------------------D°stance from nearest building--------------------- ❑ 9 Remodeling and/or repairing (describe):------------------ -----••-----------------------------------•-•----------•----•------................................ -------------------------------- ---------------------- ------------------------------------------------------------•-••--------------- •-.. -- --- -- --------'•----------•--•------- - ----------•----• --------------------••---------------•---•----•------------------------•---------------• -•------------------•------ '---------------•-----------------� hprepared this application and that the work will be done in accordance with San Joaquin County I hereby certify th ot I have p re p PP - ordinances, State laws, iind rules and regulations of the San Joaquin Local Health District. _yam � (Signed)----'-'••-�•-__ •-•----------- - ------_------------------------------------------- ------- •--------..---------- --�----......-------- -•(Owner and/or Contractor) ___ ____________ ______w----- _------ -------------------------------------------(Tltle}..._._._____..___._.___.____------------------....------ ..._.... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). y =' ( 1 FOR DEPARTMENT USE ONLY I T , rAPPLICATION ACCEPTED BY------I---------------------- -----------------------------------T----------------------------- DATE-•---------------------=------------------------•----------- IREVIEWED BY--------------------------------------------- ----- -------------- DATE r BUILDINGPERMIT ISSUED-----•---_--_--------------� ----------------------•---------------- DATE-----------------------------------------------_----------- Alterations -------------------- - Alterationsand/or recommendations:----- -•------------------------•------------------•----------,-------------.-. -------------------••-•------------------------------------------------------ +.n s a , _..__._._..---------------------------------------------__________________________________________________________________________________»».__.____-____----.--•-______.__--_____----..-__--•-_.--_•_---_._._____.__....:.- I . ...................................________ii__..______._-_.___.__._'._.__..___ _.____.____r________.______.____.__________._--------------------------------------------------------- k ................... ---------------------------- ------------------- { F k ._ ss • ' ' FINAL INSPECTION BY------------------ - ...... ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California Locil,California Manteca,California Tracyr California ES 9 REVISED 8.99 YM 8.61 ATLAS