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FOR OFFICE USE: `l �.1�.�. _4•. : ........ APPLICATION FOR SANITATION PERMIT Permit No: ....... !z,1... ----------------- ---------------------- (Complete in Duplicate) 1 This Permit Expires 1 Year From Date Issued Date Issued ... Application is hereby made to the Sandpaquin Local Health District for a permit to constru t a d install the work here* descrbed. This application is made in com 1ionc i Cou Ordinance No. 549. Ghet!ll�J�� G� JOB ADDRESS AND LOCATION_ Q .______ . __ •-__ __. A V14 �. Owner's Name...........s7 -1 Phone Address-------et-.,110--•.t�IlEPGS Contractor's Name..... 0/i?�_,0e1P4Pr0 -----------------------------------------------------------..................................... Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: J-_-_ Number of bedrooms-9--- Number of baths _t2-._ Lot size _.Z.A.Gf�------------ -...... ------------- -- Water Supply: Public system ❑ Community system ❑ Private 23"-Depth to Water Table X47ft. 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 New Construction: Yes @T"No ❑ FHA/VA: Yes I?` No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) J. • Septic Tank: Distance from nearest well...t40__....Distance from foundatigl---/a -.-_-_.Material_Z...r.,��i................... No. of compartments..-.9 artments.._ '� [�� p .._...___..�....Size+a'r.�_,1e�6.J��D_Liquid d//epth__... ...............Capaeity,�.eZ,��------- Disposal �_. Disposal Field: Distance from nearest well..�Q_....._Distance from foundation--10-.........Distance to nearest lot line-_X®....... [�' Number of lines--------. ..... ength of each line... e. .___ Width of trench. r.-..._ Type of filter material r a y yp 4 0 .- . i Depth of filter material----�tl.............Total length...,le _.�.__..__.__.__...__...__._ Seepage Pit: Distance to nearest ell-----/49_'Distance f.f fou ation_..-D_.1�1_�.D�ng to nearest lot Iin��D�.. Number of pits...... -----------Lining material---_._...__,-_..._.Size: Diameter--- - -------------Depth.-c9 .._.................. 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 ---•-----------------------------=-------------Remodeling and/or repairing (describe) y l -,owea ----•--•-----•----------•---------------------•-----•-------- ---•-------------••-------••-•---------•---------••-•--••-----------•-•----•-----•---•----------•-----------•------•-----••-•••-•---•-•------•--•-••---••-----------•-•--•-------•-----------•••-••-•-•-----•----------....... 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 nd regulations of the San Joaquin Local Health District. (Signed) `..--- - --------------( +r Contractor :: a By:----•--•-•--•-------------------------•------------------------------------------ - ---------(Title).....�* --------------- -----......------ (Plot plan, showing size of lot, location of system in relaf to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- ----- DATE © 10 Z._......... REVIEWEDBY--------------------------------------------------------------------------- ............. .............. DATE...... ....................... BUILDINGPERMIT ISSUED..............................................................—..................................... DATE............................................................. Atera s �or recommendations: •----------------------•--------------------------•---•-----•----•-•--•-----------•--•--••--•---•----...-------•------------ 5 � -------- ------------- -- -- -- ------------ ---•-------------------------------------------------- ..... ....:4 ---- - - _ --- -•-•--------------------------------------------------•------*--------------------------------- f FINAL INSPECTION BY:. '`` -------------� Date <;/.. :.. �... . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 RM 5-61 ATLAS