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FOR OFFICE USE: yfb6-----°�; h'nq -------------------- ----- --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. {� (Complete in Duplicate) -- 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 construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_...___. Owner's Name--------------��c<,��;J------•---� - '/'�------ - Address-- . �` Phone.. ,17 Contractors Name................. C-_L ---•----•--•-••--•------•-----------•------•--••......----•-----•••...... ----- _ Installation will serve: Residence (v]'�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_/_--_ Number of bedrooms . -• Number of baths __1--- Lot size _________ Water Supply: Public system 9--to- mmunity system ❑ Private ❑ Depth TO Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe A . ardpan ❑ Previous Application Made: (If yes,date_.----._______--__) No TYPE OF INSTALLATION AND SPECIFICATIONS: ❑/New Construction: Yes [:1 No (D— FHA/VA: Yes [:1No (No septic tank or cesspool permitted if. ublic seweavaileble within 200 feet. Septic Ta 1 Distance from nearest w �'�'1� �� e ) ----------tistance from foundation.__., _ _Material__.__.No. of compartments_-_-_ - -- -_SLiquid de th_ ___-_- C_.Qa acityr._G.Disposal Field: Distance from nearest 1.7.. ...Disancefoundation nc- cGrA ! from foundation.....1�'_.._...Distance to nearest lot line...__.5-/---.. Number of lines---------_.{. -_--_--__---_--_--Length of each line___-._.__ �"-••--__-•--•Width of trench------- Y'-'°------_-•__ _ Type of filter material. 7�,,�:� � Dept of filter material______%�--------_---Total ................... gth____.__.._. •�•-_•-__--.___ Seepage P t: Distance to nearest wel#)4.,,f`/ �'�� tance from foundation __. 2 `._...Distance to nearest lot line__._`..__._ Number of its._..____ •' - (n P I----.-----.Lining material_ eAt. Size: Diameter------,�-�- ----Depth---------5.-�-�---- J Cesspool: Distance from nearest well-----------------Distance from foundation_------------.------Lining material---------_...__.___..__.__._.._..._.. ❑ Size: Diameter--------------------------------------Depth-------------------------------------- ---------•- Priv - Liquid Capacity---•---•--•------•---••-----gals. Y: Distance from nearest well_________________________________ __._ ------- Distance from nearest building__________________________________________ ❑ Distance to nearest lot line--------- Remodeli -g_and/or re airi g (describe) - / a --------------------------------- 1 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 the San Joaquin Local Health District. (Signed)._)A111, — -------------------------------- ------------ • - ----------(Owner and/or Contractor) By --------------------------------------------------- (Title)---- __ __ _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., canbe placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __-__--_ _ REVIEWED BY _ ------ DATE....... BUILDING PERMIT --------------------................................................. DATE ISSUED ----- ---- ------- Alterations and/or recommendations:._____-- Gi DATE -_-- �, zf�'---------- ---------------------- FINAL INSPECTION BY: ,, - - Date---- Z 1W �.�' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton,California 134 Sycamore Street 205 West 9th Street Lodi,California Manteca,California ES 9 REVISED 8.59 2M 5-62 ATLAS Tracy,California