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FOR OFFICE USE ------------------------------------------------ ....... // ------------------------------------------ APPLI Permit No. ...1...... ATION F(�R SANITATION PERMIT ------------------------------------------------- ------ (Complete in Duplicate) ------------------------- This Permit Expires 1 Year From Date Issued Date Issued ._..: � ... z Application is hereby made to the San Joaquin Local Health District fora permit to construct and insta he klherain described. This application is made in compliance with County Ordinance No. 549. 0 JOB ADDRESS AND OCATION..............r._.._ ,.J.............................. Owner's Named -. ..�.._. .............................................................. .............. Pho A?. -��--,lt...Jr�.----.-- Address GLJ�._ f ( a �� cFJ•j ............................................... Contractor's Name.... .... e ............................. Phone................................... Installation will serve: Residence ❑ Apartment riouse ❑ Commercial ❑ Trailer Court ❑ Motel [j Other Number of living units: ---I... Number of bedrooms Z--- Number of baths IA-Lot size .......... Water Supply: Public system ❑ Community system 0...Private (Y Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam)( Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----------_--------) No ;X New Construction: Yes 2 No p FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public_sewer is available'idflhln 200 feet.) s � Septic k: Distance from nearest weIL..S.P__....Distance`from foundation..._I.P._._...._.Materiial..__... '�?K- ...... No. of compartments-----------7'_-..___.....Size.#',lZ._X.7-�A iquid depth......---------------Capacity...J.Z..V.P.. Disposal,Field: Distance from nearest well-_1&0---'-Distance from foundation.....LDI.....Distance to nearest lot line....,......... Number of lines...........f---________ - Length of each line------Pao__,'..........Width of t rench......_A.n._ ..Depth of filter material-. of_filter material al_____ Total length..........L.A.0 ..................... d / / / Seepage Pit: Distance to nearest well______W'0...___.Distance from foundation..0..'....... to nearest lot line.....Number of pits........ '�... " __-_____Lining material-/l.4-t4y.___Size: Diameter........Z.- .Z,� _......,Depth...... ...S................ Cesspool: Distance from nearest well.................Distance from foundation.__.___-__.-__.-___.Lining material...._......._........................ Cl Size: Diameter--------------------------------------Depth....................................................Liquid Capacity---------.._........._......gals. Privy: Distance from nearest well _____________________.....................-------Distance from nearest building.......................................... ❑ Distance to nearest lot line------------------------------- ------- -------------- -----------------------------•----------------------- 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 th San Joaquin Local Health District. (Signed).. ----- .................................................... /or Contractor) By: ......... ----------------------------------------(riifle)................................................................ (Plot plan, showing size of lot, location of system in re ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....�.. i .._..._.. DATE.._.__'�i � _..__� .___ . -----------•------------ REVIEWEDBY........................................................................................... --------------------•------------- DATE-----------•----------------------••------......---•-•--•-- BUILDINGPERMIT ISSUED..............................................................--------------------...-------•----•... DATE............................................................. Alterations and/or recommendations----------------------------------...._..-----------------•------------------------------------....---------...------------•-•---••........................... .............................................................. -•-.•-----••---------------•----•------------------------------•--•-•---_...__.••------•-••-----------•-•••-••---------•-----••---..........-------•------•-•-• -----•-•----------------------------•-------------•-----•------------------------------------....------------...--------•----------------•---------•--••-•------------------••---------------------------•-•................ ---•-•-------•---------------------•-----.................-----•------------...-----------------------------------------•--------------------._..-•-----•--------------------•--•---........----------------.._..----•----.. ----------------- -------------- ---------------------•--•-------...----------------------------------------••-------------------•---•-----•---------•-------•------------------•-----------------...................... FINAL INSPECTION BY: �-------------- Date..... ...................................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strout 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.89 RM 6-61 ATLAS