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Alec UrrlC.t UJt: --•------------------------------------------------- _. - -- ________________ APPLICATION FOR SANITATION PERMIT Permit No. ..... - (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued Date Issued ------ Cbl t This application is made in compliance with County Ordinance No. 549. - I?o �� Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal!the work herein described."' ' Z ,. JOB ADDRESS A LOCA N. 10!?._/ _ Owner's Name Phone ------------------------ Address---------------- ° �� Q..------- Contractor's Name - ------- .. r -• rF j Phone -••--•--•--•-------------•--- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of,living units: ----�__ Number of bedrooms .Z1_ Number of baths ---L- Lot size ..__. t Water Supply: Public system [3 Community system E] Private Depth To Water Table _1_9_ ft. F s Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Ilf yes,date------------_-------I No'k New Construction: Yes 12 No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance from nearest well__S'&__--__Distan Fe from foundation.--j-0-_-______Material____- /� _ �t --•---------------•r•--•-----..-----••- k No. of compartments .Si Size-' -- Liquid dep? h----4 ----------------Capacity...9 P Q-- t Dispos Field: Distance from nearest well: 'a_�__Distance from foundation.....�8_ ! Distance to neares of line._ �.. Number of lines--- Y E� „�'i-------------- - Length of each line__`I --� Width of trend Type of filter material... H ---Depth of filter material____ _��--.__-.Total length___--._____Q_-T _.__----_••_-----_-. W Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------f,.Distance to nearest lot line..... -11 F-1Numberof pits----I-----•----------Lining material---------•-------------Size: Diameter__.._"•.._.__k.--------.Depth---------------- ----• - Cesspool: Distance from nearest well________________ Distance from foundation------------------.,Lining materiaC.__.___._____ ❑ Size: Diameter------i.-------------------- ----------Depth_---!-----;----------------------------------------Liquid�Capacity gals. . Privy: Distance from nearest well-------------_________________-- -I---_-_.___._Distan a from nearest buildingI ❑ Distance to nearest lot line-----------------------------------------•= Remodeling and/or repairing (describe)_----------------------------------------------------- ------------------- ---------------.------------------------------------------------ -----------------------•--------- ----••--------- # ! .. ________________________________________________ I .+..-.-.... :..r ---------------------------------------------------I--- ----------------_--------------------------------------------------------------------------------.---------------.......__...........------------------------- I hereby certif that I have prepi red this application and that the-work will be done..in accordance with San Joaquin County ordinances, State a s, and rules re late of the San Joaquin Local Health District. (Signed) ---------- --------S--- _— r_:.- ,, _i�. / ----- -- ---- ----------- -' �'.�-.� nor- ----=-------------- --- Title----------- By:---------- �d o r Contractor) �. (Title) ' Pot plan, showing size of lot, location of system in relation to we[ , buildings, etc., can be placed on reverse.side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- ' --------------------•--------------------- -------------- DATt ~ ---------- VIEWED BY... - - -------------------- DAT -- I ------------------------------- BUILDING PERMIT ISSUED------ ------------------------------- •---------------------------------------•--------------------- DATE. Alt --------------- erations and/or recommendationst-------------- ------------- ---------------------------------•-•---------------- -••---...-•-------•-----------------••--------------- ---------•-------••-----------•-----------------••------•--- A------- 1 -----•-------- ----------------------------------------------------------- FINAL INSPECTION BY -------------------• Date------A." ---- 3 ------------------------------------------- J SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street300 WesT Oak Street )Lj 124 Sycamore Streif 205 west 9th Street Stacklon,California Lodi,California Manteca,California Tracy,California ~ES 9 REVISED 8-59 2M-5-82-ATLAS _