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FOR O,F.-F�IGE•kJSE: s . ' �c�/ - .-�=.-- 'a. S t;.. Permit No. .../. -- ----- " APPLICATION-FOR .SANITATION PERMIT F_ -- - � ------------------ �� - ------ --------------------- (Complete in Duplicate) Qate Issued -------------------------------------------- This Permit Expires 1 Year From Date Issued ._........._7.__... s 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 Cou/ntty O ance N0.� JOBADDRESSVD010 . .. _.. _.__f...:` �� ------------••-"----------------- -----------------------"-----•-•--••------.. Phone........ Owner's Name... 1. Address. - - -------- 4 = - •- --• -----••-••--••---••--.....---•----•---••••---- _ "�"�` ------• Phone--------••--•- ---- ( Contractor's Name..--...--••----------•-• i Installation will serve: Residence Apartment House [:1 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .. Number of bedrooms Am?-- Number of baths /---- Lot size _ ------------••••--•---- Water Supply: Public system �ommunity system El Private ❑ Depth to Water Teble Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [3 Clay Loam [D Clay E] Adobe Hardpan C] Previous Application Made: (if:yes,date--------------------) No ❑ New Construction: Yes ❑ No J2-1�HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I .I S 1 ank` Distance from nearest well_________________Distance from foundation-_____-.--: !- Material------------------------------------------------- .. dept No. of compartments-----------•-----••------- ize-----------_---------------=---Liquid h------------ ----------- Capacity s d: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line................. Number of lines-----------------------------------Length of each line--------------------------....Width of trench------------------- --------------- f Type of filter material _________________De Depth of filter material___..._____-____r__Total length---------------------------------------- 5 ___....___________._____ ._...____._� Seepage Pit: Distance to nearest elle.-.Qistan m undation,`.!,��.___._.Distanc�fto nearest lot line 4 - k Number of'pits------ -----------Lining mater ---Size: Diarneter_:__3.3----------.Depth------ 4S---i --------•- ` ' Cesspool: Distance from nearest well_________________Dist rom foundation_'-..._.___._____-_.Lining material.._--__-...___-_--______---.--.-..___ •-,,_._. ............................gals.Diameter----------------- --------------------pepth---------•-•---------- ----_--- -----------------.-.Liquid Capacity❑ Distance from nearest building Privy: Distance from nearest well -. -------•--------•----------- --- � - ---❑ Distance to nearest lot line------------------------------------------------ --------------••-------.........................-............•........------------------ V Remodelingand/or repairing (describe):---------------------------------------------------------...................t-•---------•---------.-_----••---------.-.---------••--------•---------------- -------------------------------------------------------------------- ------ -----•••------------•---------------------...--.--------------•------•-••---- ,.. .. -•--------------------•---------------------•-•-------------._.._..---•------------------------•-------•-------•----..._------------------------ ;. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,_SfatpAqvs. and rules andVregations of the San Joaquin Local.Health District. (Signed) L •` ---------- ----------------•---------•--- - . nor and/or Contract - - ��lvl/ d/o or] By:----------------------------------------------------------------- (rifle) (Plot plan, showing size of lot, locaflon of system in relation to we s, buildings, etc., can be placed on reverse side). E FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED:B5___ a---- ----------------•- - DATE------ 'x' i 4 .�.Co.�.e---"-------- REVIEWEDBY-_--------------•-•--_ ------------------------------•-----------------••---------------------------------wml.•_. DATE-------.-_--"-----------.------_----------------------- BUILDINGPERMIT ISSUED----•---- ---------- ----------------- ------------- ----------= DATE---------------------------------------------------------, Alterati and/or recom enctations•... - ........ 7 -`__ 10 FINAL INSPECTION 6Y:.._.- zP-.� �F � Dated=�� =� --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wait 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED e•39 YM 3-51 ATLAS 4