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rVKUrrlLt St: -- -"-- -1 - 0-------------- APPLICATION FOR SANITATION PERMIT Permit No. ..1./1.� ----- --------- ---------------------_ (Complete in Duplicate) - -- This Permit Exaires 1 Year From Date Issued Date Issued ....`.I 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..___ _._. -- tQ .cam- Owner's Name--------- _-rr'? c '2� _l__.a;<&--- Address----- •°X - _ ------------------------- Phone.................................... `---:��-_!►� -------�--`/3.--------`S-r-�---=�_Tt'�(/'...---CfH - �__ ----•--------- -------------•--................................................. Contractor's Name......... ..:........ n�� ,,,2� �J Installation will serve: Residence ❑ Apart me House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other " N Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ® ��'�fhec/d Water Supply: Public system ❑ Community system ❑ Private IC Depth to Water Table -4._7 __-- ft. Character of soil to a depth of 3 feet: Sand ElGravel E] Sandy Loam J' Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No,® New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: Y__15 FHA/VA: Yes F1 No ['f (No septic tank or cesspool permitted ifublic sewer is available within 200 feet.) P,-C C,q s T V►`e-,Y S--ptic Tank: Distance from nearest well—Tr ------Distance from foundation----i�r.._..__.Material---c v._C qle ® No. of compartments__.____._-!;�t...._" J-� - Disposal Field: Distance from nearest well---- __"--Size__ .s tc' 9' ---------Liquid depth...... ---------Capacity..k .... "--."Distance from foundation--------------------Distance to nearest lot line....._...._...... Number l lines______________ Z ........... Length of each line___"_-_______-__-______.."_.-.Width of trench---:x.46-"--__"_-_-_........ Type of filter material, -------------- of filter material-------%r"".-_-" U� - - Total length.__.�..___..... ------------------------- eepage Pit: Distance to nearest well______________________Distance from foundation__.._....__......__.Distance to nearest lot line................. ❑ Number of Pits----------------------Lining material-----------------------Size: Diameter__-------_--_. ---------Depth----•------------•--------------- Cesspool: Distance from nearest well.----------------Distance from foundation--------------------Lining material..................................... ❑ Size: Diameter------ -------------------------------Depth---------------------------------------------------Li Liquid Capacity-. q ------------------------•-gals. Privy: Distance from nearest well------------------.---------,-------------------Distance from nearest building Distance to nearest lot line-------------- ---------•--•---------------- -----------------------------------------------------•------------------------------ Remodeling and/or repairing (describe):______ � l - -----------------------------------------------•--------------------------------------------------------------------------------------- -----------------------------•---------------------------------------- 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 the San Joaquin Local Health District. (Signed).............e_. = � -------------------------------------------------------------(Owner and/or Contractor) By:.....----- ' .... Title CCI (Plot plan, showing size of lot, loco of s e in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- _ ,-�.�,�---------------------- - DATE .. ..........-------------- ---------------- ------------------------------------------------------------------------------- BY............ ---------------------------------•------------------------ DATE BUILDING PERMIT ISSUED------------------------------------------- --------------- DATE Alterations and/or recommendations_______________"."-"""_-_-."""-_,--".-.---"_--_ ---"--------•----- ----- ----------------------------------------------------------------- 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 8-99 2M 5-61 ATLAS