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FOR' FF10E USE: _ . ___ _ ..--..-- .�_ ts. APPLICATION FOR SANITATION PERMIT Permit No. X3.3 I �.-4---------- ----�---=- -- '�'•=- (Complete in Quplicatej � j . This Permit Expires I Year From Date Issued Date Issued ...... .L..._____-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. " i This application is made in compliance with County Ordin ce No: 9. JOB ADDRESS A LOCATION- - --------- -X-------------- ```` ``--� Owner's Name__ __ ... ..-- �fes_-- ------------- Phone_/7xv.__�_Ie,`z Address-----•-•_ -------��- ------------------------- ---- .......-................................................ Contractor's Name__ ___________ ^ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ________ Number of bedrooms _�'. Number of baths _" Lot size -------..............................--------..�__.__�__`- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth TO Water Table -------- ft. i Character of soil to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes, No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ NIQ ' i aJ'q v TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e tic Ta - Distance from nearest well_ `'Distance from foundation'-_ ys --------Material------------------.__.._.-_______________________ h No. of compartments--------- - Size---------------------------------Liquid dept--....----- ----------Capacity posal lel - Distance from near.1st wellA ._Distance from foundation...,�.V......Distance to nearest lot line______,lL .. Number of lines- Length of each line---- �•----- Width of trench-- Number Type of filter materia�aEc�Lf'___Depth of filter material.-__._�__ ____Total length__ ________________7`-_P________ Sit Distance to nearest well_/�e _.Distance om oundation__s __(a______.-Ds�ista ce to nearest lot line__/#-_ __. Number of pits----L_______________Lining material_ ._ ........Size: Diameter__0�__.. Depth_ �._ Cesspool: Distance from nearest well___._.____.__-._Distance fro oundation--------------------Lining material---------------...................... ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____._________-____.___._--___._._-_____. + ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------•----------- Remodeling -•- ••---Remodeling and/or re 'ring (de cri e) .. - -_/ i �.- ------------------ .�-------•------ ------- �. i--.-. - --------------- - -- -- ---•- --- - .... T _ ___ _ ________ ::_:__ 1 hereby ce XfThnt Ihave prepared this applita o and that the work will b ne in accordance ith San Joaquin County ordinances, St nd rules regulati of Sa Joaq ' Loc alth istrict. i (Signed)----------�------ ------ -- --- �- ------- --- --- ------ -- -- =tee rte.-` {��Contractor) ( le (Plot plan, showing size of loft, location of system in rel on to we s`, buildings4 , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------------------- --------------------------------------------- DATE------.. ------------•-------•---- REVIEWEDBY------•-------------•---•-••-•--------....__--------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED_-_-•-------•------•--------- -----•-------------------------------- ---- DATE-------------••----•-- ------ . . _Alterations and/or recommendations:__ - -------------------- •---• ---- --- - ='-' FINAL INSPECTION BY:. *6X& ------ Date--- --- -- .. ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Strait Stockton,California Lodi,California Manteca,California Tracy,California y "' ES 9 REVISED 8.59 ZM 5.52 ATLAS '