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rU14 oFF E U E. ---------- - --------------? -- ---"(��f�� `- �� APPLICATION FOR SANITATION PERMIT Permit No. ...._.J`�._~. - (Complete in Duplicate) ------------ -- This Permit Expires 1 Year From Date Issued Date Issued .__----- j 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. s JOB ADDRESS AND LOCATION..... py - Owner's Name....�-. -- ---- .._. = T...................................5. Address 3 -------------------- ------------- J..-_,y.---C---•---••i=--t-- •- -------------------••-------•---•---------•------ Phone.................................... �.f--.... -. --------•-•------•-•-----------•-------------•---------...-..........••----------•---•-... Contractor's Name `� " ! __19002✓L c5_ QA/ S'. ---------------------- Phone.......... Installation will serve: Residence [j3,1 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ---/_. Number of bedrooms -- - Number of baths J.... Lot size .._--�. .. ............ ! V O Water Supply: Public system ff/ y y ❑ Private Depth To Water Table . X Z . !� Community system ❑ p ,� ft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe Er Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 2"' New Construction: Yes ❑ No ET'-FHA/VA: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan ;� Distance from nearest well_-__----_----•-Distance from foundation--------------- -.--.Material-------------- Na. of compartments---•---------------------Size-------------------------------- Liquid depth--------------------------Capacity....................... Disposal Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line---- _-...--...... g , � ® Number of lines---------•-------------------------Length of each line----.---_-•--------__-----•--.Width of trench--------- � Type of filter material, --_------------------Depth of filter material---.._-_----_-_ '/ -----.-.Total length----------------------••--------...------- Seepage Pit. Distance to nearest well--- __Distance am foundation--_._,J(?.�....Distance to nearest lot line--. ... Number of its.-.------ - 0jL-_-Size: Diametei-26`r _ - + P -�------ ---Lining material-.._- De th----•----.;�.,�--•----_-_-••-- Cesspool: Distance from nearest well----------------- p Distance from foundation--------------------Lining materiel.-.--.------_--________- Size: Diameter---------------------------------•----Depth--------------------••------------------- , --------Liquid Capacity------- gals.PrivY: Distance from nearest well ❑ Distance to nearest lot line- ------------------------------Distance from g nearest building ' - --------•--•----------•-----•------------ Remodeling and/or repairing (describe)----------------------- - -- --- -------- - ------- ------• - -•----•----- - - ----------- -------------------------------------------- -------- ........ ----------"-----•---------------------------------------------- -----------•-------•-•-----•---------•----------•----------------- ---•----•-----•----------••-•---••-•--••--•-----•-------------- 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. (Signed)•--------- --- - ------ ------(O her and/or Contractor) - --- ------------- By:..........s - q si -------------•---------------------------------------{Title).------ (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ ---------- --------------------- DATE--- ----- �' -----------•----- REVIEWED BY-------------•----------•------------- ------•- ---------------- ----------------- ------ ----• DATE--- • --------- BUILDING PERMIT ISSUED-,---------------------------------- ------•---------------•---- Alteretionsand/orrecommendations:- _ 2e-- c_r: - _ J /!'� -�' --• - - - --•- -••--- - � ..--..----.. -------------•-----------•------•-----------------•----••---------••--------...- ----- ----•-------•--- --------------•- // 3 w e/� FINAL INSPECTION BY:-_---- lla/ _ «� � Date------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South An+erlcan Street 300 West Oak Street 124 Sycamore Stmt 205 Woof 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REVf5ED B•59 2M 5-62 ATLAS +