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t.� ------ --- Gfi' � 11.1`__ APPLICATION FOR SANITATION PERMIT Permit No. ..l...�_ -r (Complete in Duplicate) � This Permit Expires 1 Year From Date Issued Date Issued 1_� 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. i JOB ADDRESS AND LOCATION-.__ Owner's Name...... ..•-------- _ ----•---.-- ---•---- -----•----•---- --------•----------•-----•- Address- -... Phone Contractor's Nama... ----------------•-- Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I... Number of bedrooms .,.�__ Number of baths //Z- Lot size ._. x_- a4 - Water Supply: Publics stem -"•---------•-"------- y ��ommunity system ❑ Private ❑ Depth to Water Table '��ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_.:- ___.___---_._) No New Construction: Yes No ElFHA/VA: Yes ❑ No ®--� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Ta • Distance from nearest well________________Distance from foundation oundation__________--___.._.Material6 No. of compartments--------------------------Size----- - -------,_--Liquid depth-_---••----------_-_-.-.-_-_-.-_-___Capacity _._a acs• t_-Y._---_• ------•-.-.-.......-......Dis l Distance from . s nearest well__________________Distance from foundation--------------------Distance to nearest lot line.......... Number of lines----------------------------- -----Length of each line---.--------------------------Type of filter material------------------- Width n trench--------••---•--.-- ePt of filter material Tota! length -------•-------.•--------•---- Seepage Pit- Distance to nearest welV740 -------Distance fo ndation... �► �42-._....__..Distance to nearest lot line._.••-- L#F Number of its__ . y p •�_______________Lining material._______- ------ , • -_..Size: Diameter__.- _ ,3 Cesspool Distance from nearest well------ Distance from foundation__._.---____-_____-Lin g materriapth-.__.._. -::• _ s. . . ❑ Size: Diameter______________ -------- -----•----•----Depth----------------------------------------------------Li uid Ca acs Privq P tY----------------------- ---gals. ❑Y Distance from nearest well__________________ _______________________ -Distance from nearest building ! Distance to nearest lot line-------- ----•-----•----•---- ----------•--------•----------- g--_......__.----- -•-------------------•..--•-•----•- 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 regula ' ns o the S n Joaquin Local Health District. I (Signed)-----------------------------------•••---•--• 1 ------------------------------------------------------------------- By: (Owner and/or Contractors ---•----------••-----••------•-- ----------------------- -------••--------•-------[rile) (Plot plan, showing size of lot, location of system in r lation to wells, buildings, etc., can be placed on reverse side). ''FOR-DSP RTMENT USE ONLY APPLICATION ACCEPTED Y- ---------------------7REVIEWED BY---- - -----------------...D..A -j- . . .--- ------ / _ BUILDING PERMIT ISSUEDtf ------- --- DATE---------- --- ---------------••----------------- ------------ --------- ;---------------- DATE. Alterations and/or recommendations:_._i_--i{-- , tT" •---------------- ---------------- FINAL INSPECTION BY:----- --_..------- . Date__. -----------------••--------- SAN JOAQUIN LOCAL. HEALTH DISTRICT 130 South American Street 300 west Oak Street 124 Sycamore Street 205 weal 9th Street Stockton,California Lodi,California Manteca,California Trac E8 9 REVISED 6-89 YM 3'61 ATLAS y,California