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FOR OFFI T E: _ r --___-- .. /6__z---�f_�f_. APPLICATION FOR SANITATION PERMIT Permit No. ... ---------- ------------------------------------------- (Complete in Duplicate) Date Issued .y...�l..........�' Z" --------------------------------------------------------- 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 LOCATION... . ...�.. Owner's Name....j-- •f -------•--- � � .................................................. Phone.................................... Address - - fit. + ----- Phone...............• Contractor's Name. ?'`- -----.. ................... Installation will serve: Residenceg Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/.. Number of bedrooms _. ,Number of baths _1.. Lot size ._.. y __ .. .�.._..... 41 Water Supply: Public system j5ff Community system ❑ Private ❑ Depth to Water Table ....... ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay g Adobe Hardpan ❑ Previous Application Made: (If yes,date-------- -----------) No ❑ New Construction: Yes M No ❑ FHA/VA: Yes ❑ Noj 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_/e7,C Distance from foundation_ZQ........Material----. Ar No. of compartments---------�..........Size...;�A...s..., .. .__.Liquid depth__......__.`__....._Capacity....f. °a Disposal Field: Distance from nearest well_---..— Distance from foundation...../.& .......Distance to nearest lot line................. ,® Number of lines....................:....._-_-,-_--Length of each line------------- '_G.___....width of trench...........�#... _............. Type of filter material.-.-.�/-. .t-__Depth of filter material....._/.. _...._...Total length......._.�jp...................... Seepage Pit: Distance to nearest well___,?.!!!�!"------Distance fro foundation_...J.._0..�_.Distance to nearest lot line.....1�_. ..*. VNumber of pits_...-`-*..............Lining material.._.._��__' Size: Diameter........... F Depth.......�T�_�....._...__.... 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-----------------------------------------------------......---......-------------•-----•----•---•--------•---•--------------•-•-------------. Remodeling and/or repairing (describe):._ ..............................................-...........................................................................................................................................•---------------------------------- ---------------------------------------------------------------•-----•--------------------------------------------------------------------------------------•------------•------------------•-------------------------------- ------------------------------------------------------------------------------•--------------...----------•-----------•-------------••---------------------...---•--------------•----------------------------...._......_._.. 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) r' r! j ---------------•-------------------------------------- (Owner and/or Contractor) By:..... ---- --- --------------- / 1 -------------(Title)............................................. --------------- (Plot plan, showin size o lot, location of syst in relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 44 APPLICATION ACCEPTED BY• ,.---- - ---- ...............................-------------- DATE......... ! -f. ---.& �L........... REVIEWEDBY ------------ ----------------------------------------------------------------------------- DATE........................................................... BUILDINGPERMIT ISSUED.............................................................._...................................... DATE............................................................. Alterations and/or recommendat�sf............................... -------__ ....... --. - =x'_ a ze � /tel -!?�1� ._ ... �; -�-- . ------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:--- 1 -------- ------- ' `--'C--------------- Date......!'��_ l�� Z--------------------...-------- 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 8-89 EM 8-61 ATLAS