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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------------------- ---- ---- --- (Complete in Duplicate) r— b-L'3 - -------------------•--- ----.-.-_----------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to onstruct and install the work herein describe This application is made in compliance with County Ordinance No. 549. � JOB ADDRESS AND LO ION...--------L -(------------ ,t----.. ..../___- _�- . .......- _ Owner's Name --------• / .� Phone_ `---`' r'3 Address -5 ---------- ------- -------- Contractor's Name.. -.°Phone- ------------••-•-------------- 7House �-- ---- ------- �. n. ..c Installation will serve: Residence Apartm ❑� Commercial ❑ Trailer CourSr ❑ Motel ❑ Other ❑ Number of living units: .-- .. Number of bedroom�3�Number of baths .1_-_ Lot size ------------ --- ....... Water --...........--...- Water Supply: Public system ❑ Community system ❑ rivate [T'Depth To Water Table_3.4_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [r-Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No � New Construction: Yes ❑ No p `IA/VA: Yes ❑ No E-- TYPE OF INSTALLATION AND SPECIFICATIONS: 190-0 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_!�?"_Distance from foundation-----/_�........Material-...... :......................... ...___ No. of compartments..------.-_L—---------Size....G�-X_3--- Liquid depth..........�/-----------Capacity....>.- ----`---r-- Disposal Field: Distance from nearest well.- y!f?:-Distance from foundation..-3._v-_--.-.Distance to nearest lot Number of lines------------- -----------------Length of each line............ -........Width of trench----------- -r-:__---------- Type of filter material_- ------.Depth of filter material___ ff...........Total length........ ........... Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------..Distance to nearest I-af line...__---_---__._. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------....-..._. ---_--------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----.-.-----.-- .-.---.----__------_ ❑ Size: Diameter---------------------------------_.-Depth----------------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well------- -.-----Distance from nearest building----------------------------------------.. ❑ Distance to nearest lot line------------------------------------------------------------------- --...-----•-•------•--------------------•---------•------------------- Remodeling and/or repairing (describe):------/ --------------------�'r7- --------_-P.! .......... - -•- - - =�� •-••--••..............................................•--- ---•-�.'-""'�� ------------ ---------- ------------------------ -------• -------------------------------------------•--------•--------------....---•-----...-------------------•---------------------------.....-..------•---------•----------------------•-----------•----------------------•-------- -•------------------------------------------------------------.-------------------------------------------------------------------------------------------------------------••----•--------------•--------------------- I herebAcer"tify hat I hav prepa ed this application and that the work will be done in accordance with San Joaquin County ordinances, and r an egulations of the n Joaquin Local Health District.- -------- f -------------------------------------------- (Signed) (Owner and/or Contractor) 8 {Title)----------------------------------- ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ DATE/ -Z---• �� REVIEWEDBY----------------------------------------------------------------------- -----------------------------•-•------------------ --. DATE....---- ---•---------•-----.......-------_------------- BUILDINGPERMIT ISSUED----------------------------------------------•--_------------------------------------------------- DATE..-.----•--_------•--_-------------------- ------------- Alterations and/Sr recommendations• -------------------- ..r.- _._.---_.._.----'--•--•---..-..- �.'.�,.,'..x................ .------- -_/... ------------------- -------------- •-------------•-------•--••------------------------------------------------------------------------------•--•--------------------------------- ---------------- .._......-:�kh5---- ��ST�l�1 '`u� f _srRc } --------j..---►-n��-�'�7`��------- -------. `�► �-a )'�_..•-...-. ? _.--. . 1'9' f- ,1 � - > 1-IT` Q------•---- F�-L�--F--...... 1 fR. D FINAL INSPECTION BY:- Date----. t�---- Q - 5 ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Stmt 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS -^-.,