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FOR OFFICE USE: . ka�� _ APPLICATION FOR SANITATION PERMIT Permit No. ___f.. . ...- . . - / (Complete in Duplicate} .��2 / , {� .._.... Date issued ----------------11"--� •,,. ---_--------_-----.-- ( . - -------------- This'Permit Expires 1 Year From Date'Issued R .�. 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 gwith County rdinance . 549. JOB ADDRESS AN LOCATION /.- l._.... g - ---•--- ------------------ Owner's Name........ ---------- ---------------------------------------------- Address ---•----------------------•----------------- _. Phone........ Address----••-----------•......-••-•----- -------- --------...•-----------.....---•-•-----------------------------------------•---••----•------•--- 71EContractor's Name ........ ---------------- Phone................................... Installation will serve: Residence [j-�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 Number of living units: -__Z Number of bedrooms 3-- Number of baths ._-'2-. Lot size ..-I pr�._I _ ............................. Water Supply: Public system 01-t-ommunity system ❑ Private ❑ Depth to Water Table 5.6_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EY"Hardpan ❑ Previous Application Made: (If yes,dote___________________) No [!r New Construction: Yes E5--No ❑ FHA/VA: Yes ❑ No ® __ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticiTan Distance from nearest well_________________Distance from foundation--------------------Material•_____________....-------------------.-.--.----. No. of compartments--------------------------Size-------------------------------.Liquid depth--------------------------Caaci Disp a1 Fie Distance from nearest well------------------Distance from foundation--------............Distance to nearest lot line----------------- lNumber of lines-----------------------.-----------Length of each line....--------------------------Width of trench-------------------------.-----.--- -= Type of filter material-------------------------Depth of filter material-----------------------Total length-----..----------.._-•----•--.......__.. il See 1•i!--Atff Distance to nearest well.—jur-Kd._.-_--_Distance f foundation..YO..............Distance to nearest lot line.._ X1 ��(fi - �..__4------' ----------- '� Number of plts___.____�___-..---__Lining material_______!.].¢--I'-___.Size: Diameter____.__..." Depth____.____.�<_.____ Cesspool: Distance from nearest well_________________Distance from foundation.---________.._.__.Lining material_-__________-_.-.-_-______ ......... \ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------._........- Privy: Distance from nearest well________________________________________ ______Distance from nearest building--------------------...................... ❑ Distance to nearest lot line------------------------------------------------ -------------•--•-----------------------••----------------•-•----------------------•-------- Remodelingand/or repairing (describe):----------------------------------------------------------------------------- ----•--•-••----•------------•-------------•-•------------------ --------------------------------------------•-•------------•------------•--------------------------------------------------------....-------------••--.----••------------------------------------------------------------- I -----•-------------.-----------------..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 reg ti s of the San Joaquin Local Health District. (Signed) --------- - --------------------------------•-•-------------------------------------------------(Owner and/or Contractor) rBy:---------------------------------- ---- ------------------------------------------ ---------------(Title)......-•----------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- __�.__- ___-_ -.-�4'?:- ----------------------------------------------------- DATE---� � L' JJ ------------ REVIEWED BY------------------------------------------ - ------- ---•--------------------- -------------------------------- DATE------....------------------------------------------•------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE..-.----•----••-----••--------------------------------------- Alter�fatiorn�s and/ `r commend'atio s:---•---------------- --------- ------ ------yl'_ ------- - ........I—-------- ---------------------------------- -`..� lF- ..`.... L ��1 ---`-- � '+' �"1 htC�if� ��" - ------------------------•------• -----•-•------------------------- -----T----------------- --- ---- --- I FINAL INSPECTION BY:. = •` '`-- ------------- Date__C `"` !-__'.�P ------------------------ -- .....--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-89 YM 5-61 ATLAS