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FOR OFFICE USE: ... -----°--`=�''--------------- ' ._ APPLICATION FOR SANITATION PERMIT Permit No. � 7. --- -------------------- Date Issued li (Complete in Duplicate) ................. .................................... ... This Permit Expires I 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 C unty Ordinance No. 549. JOB ADDRESS AND LOC TI -± : a- / .... Owner's Name .. Phone-----•-----------•----------- . Address--------- •�J�,' ----_-- '. e 1 Contractor's Name - r --------•-------------------------- Phone tQ.ttiQ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` v Number of living units: __f-. Number of bedrooms .7--- Number of baths __/_ Lot size .. � �- - ,<Q '.------_.-..- Water Supply: Public system ❑ Community system ❑ Private Qr Depth To Water Tablej:5'Cr ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W Hardpan ❑ Previous Application Made: (If yes,date______________-------) No;!( New Construction: Yes 2' No ❑ FHA/VA: Yes ❑ No PT TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.S�Q-.-..Distance from foundation.A ...__.....Material..... . ........ .............. ............. No. of compartments.._-_ ..............Size._.r.�l�11Xjr.....___Liquid depth.___,x-.-------------capacity147Ga-I&. d1- Disposal Field: Distance from nearest well__-----Distance from foundation---/---- ..Distance to nearest lot line---%a..... ... Number of lines------_��.....,�..p.......... Length of each line___: �v-_f f.-_...Width of french.....�.�`-----....._-- CIO Type of filter material._ik_ _______Depth of filter material..l�_------______Total length----,��o_...._-.._-.._...__---- � Seepage Pit: Distance to nearest well--/0--------Distance fjo�mfJ;undation._Z-B_�..__.Distance to nearest lot line__�.�..._ Number of pits._._------------Lining material. 4 C --.---Size: Diameter...-7. -J.`�....Depth__pl.sy.................. Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material..-......---_-_...._...._...._...._-- ❑ Size: Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-____-_-•--.-----__-.--_-_------__.-.----. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or r pairing escribe): -- ` _/ .Q --------- ------ -------------- ---------'� --•------- ----------•-•---•-------- - �_ .. - -•--------- --. vt. ' ... ------------------------------------------------------------•----------- --------------------------------------I--------------1............ ----- -------------------------------•--------------••--------•------------•-----------------------------------------•-------------------------------- I hereby certify that 1 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)--------- - ------------ -- ------ r-A --------------------- -------------------------(Owner and/or Contractorl o BY= ---------- -- - - --- - --- - -- {Title)----- - -- (Plot plan, showing size of lot, Ioof system in elation to wells(b I Ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. -�+�r� ----------------------------------------------- C 6r -- ...... :.� DATE.. '--------•f - REVIEWEDBY ----------------------------------------------------------------------------------------------- DATE---.-..........----...._-_--------------------------------- BUILDINGPERMIT ISSUED--------------_----._.--------------___------•----------____--------------------------------- DATE------------------------------------------------------------ I Alterations end/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. E9 9 REVISED 8.59 2M 5.62 ATLAS T J