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FOR OF- E SE: � •� . 3 s :~ APPLICATION FOR SANITATION PERMIT Permit No. _2.. ...... . , 3'JTlicate in Du (Complete p ) Date Issued .. 3 ..•.�� v - -- ------------- This Permit Expires 1 Year From 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 LO ON _ � i tom. . 1 Owners Name.. ----------------- Phone.................................... k Address ------ � - Contractor's Name............. . . __-....- ---- Phone----------------------------------- Installation will serve: Residence R2,- Apartment House ❑ Comm ial ❑ Trailer Court ❑ Motel ❑ Other 0 Number of living units: -f____ Number of bedrooms ,,, . Number of baths . Lotze Z I Supply: Public system ❑ Community system ivate ❑ Depth to 1Nater Tablet. Character of soil to a depth of 3 feet: Sand ❑ Gravel I] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date-----.--------------) No New Construction: Yes m/IQ`o ❑ FHA/VA: Yes Flo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Saptic Tank: Distance from nearest well -_ ___.Distance prom fndatn_ � ___._-Material____ . , ' .......... y t No, of compartments_____, '______________Sizes�l-�_ p, .Liquid depth____0-_____._..________CapacitylZ ..... Disposal Field: Distance from nearest well...._ter.....Distance from foundatio ..*/V.-......Distance to nearest lot .......... Width of trench--"2- ............. ... ... ........ �y Number of lines__.._____�+___�.____.______Length of each line___.__�efy _______ � / j Type of filter material._ epth of filter material----/�h-----Total length___-,,f-�-....................... ' Seepage Pit: Distance to nearest well___-----_______Distance Tf�j M fou dation____.4,0_ _`___.Distance to nearest lot line___ Number of pits------�-----------Lining matgrial__4. Size: Diameter__ ___ U., ------Depth--,2,0.--/--------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material....................I................ ❑ Size: Diameter-------c;'----------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- r Privy: Distance from nearest well__________________ ---------.------.------Distance from nearest building____--___--.--------_-----________-__.-. ❑ . Distance to nearest lot line...... -----•------ ---•------- --------- --------------------------- ------------------------------ ......----•------•------•- Remodeling and/or repairing (describe ---------- k _-----,_.. i. -�------------------------------------------------------------------- ------------_............_______----------------------------_------_-------------------------------------------------------------------------------------------------------------------------- a --....-.mss..... ^,–.-"Mt—�t 1� __..._.__._. . .._ :_ __...... -----------•--------' •'-P-----------------PP------•-------------•---•-----------------•--------•----••---------------•-----•--"-------..._---.............._......_______.._._--- I herebycertifythat I have prepared this a licatic, 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 Disfrict. [Signed] ----------- ----------- -----i------- -- ------ ---------------------------------------•---# ( r Contractor) • .! f (Plot plan, showing size of lot, location of system ' lation fo-wells,buildings, etc:.kcan be placed on reverse side). OR DEPA TMENT USE ONLY F APPLICATION ACCEPTED BY -- 'A- -�------------------ DATE---------4 ----------------- REVIEWEDBY----------------------- ---------------------- ------------------------------------------------------------- DATE---------------------------•------------------------------- i BUILDING PERMIT ISSUED --•` ----- – .... DATE Alterations and/or recommen a+ions: - �� -- -- --.-.-_fid-�{�,�-- -1 .-.........---------------------------------------- ------------------------------------------------------------------ ` --------------------------------------------------- --------•-------------------------------- -------------- FINAL INSPECTION BY:. ... . . .... .. ... ----- Date-__10.__`:.... '. ..... ------•----- --------- SAN JOAQUIN LO AL HEALTH DISTRICT 130 South American Street 360 West Oak Smoot ._ _ - '�134 Sycamore-Stmott 305 West 91h Strout 1 ; Stockton,California �.� Lodi,California Manteca,Californ 40 tTroWr California /f ES 9 REVISED 8-99, ZM 5-41 ATLAS4 ��//� �,,, .�.� � � � ��y e w_ _/{ ]� If �