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FOR OFFICE USE: --- - -- --- ---- -- APPLICATION FOR SANITATION PERMIT Permit No. ..... 4....,..3 ---------------- - --------------------- --------- (Complete in Duplicate) #I-h 7— This Permit Expires 1 Year From Date Issued Date Issued ..... ............... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. r This application is made in compliance with4 dinanc County Or9. f 4A,44r � . .•ems->< .�3� JOB ADDRESS A LOCAT N--.._ L_ ►M'4�. Owner's Name..... e -• ..... . ------------------------•--- ------------••----•=- Phone... Address__...?! ....�__ ...... 4 .... -- Contractor's Name..... , .._............ Phone..-.Q_.... ..�.0.Q.1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ++Nlpt ;� el [IOther Q Number of living units: -__I.._ Number of bedrooms .__ , Number of baths ._l.... Lot size ._....1.�_...I.......bAjC,,%A.................... Water Supply: Public system ❑ Community system ❑ Private;g Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: a Distance from nearest well.................Distance from foundation....................Material................................................. ❑ o. of compartments _.._ T ---_Size................................Liquid depth_-......._................Capacity. ............. s Disposal Field: listance from ne-arest',well-71 _�"�Distance from foundation.10.*'71._._.Distance to nearest lot line __ :nL–, Number of lines.._............t---------------..-Length of each lineO�_....___._...Width of trench__._ ----.----.--..---• Type of filtef ineferlal.-.?.04_X.....Depth of filter material......1 //__-__Total length....... .40.. Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line:................ ❑ Number of pits......................Lining material.......................Size: Diameter........................Depth--............................... 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 ----------------------------•------Remodeling and/or repairing (describe):-- ---- ------ ------------ ••------------ --- ......-•••-•--•-- •••--......•--------•---•• ------------•---•••---•------•----.. ..............-••---•-•--•-----••--•-••-•---•---•=•-•--••----------••-•••----•-----••-•-----••••--------•-•••-----•••--•----••--•--•-----•-•-------------------•------••---_----------- I hereby certify that 1 have prepared this application and tfiat the work will be done in accordance with San Joaquin County ordinances, State s, and rules and regulations of the San Jct quin Local Health District. (Signed) --- -------- ----------------------------------------------------------------•------ T (Owner and/or,Contractor) By: ---•••••(Title)------------------------------------------- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed oh reverse side). F211 DEPARTMENT USE ONLY APPLICATION ACCEPTED BY• . t .. ----- DATE...• -'- .' -<<' REVIEWEDBY-----------•--•--•-•-•-••. ............ . ................................................................................... DATE---•-----=-•----•--•--•---------•--•--•--••••---•--•...--•-- BUILDING PERMIT ISSUED-- :.. fe -----•--------------------•-----------------------------••-- DATE............................................. Alterationsand/or recommendations:............................................................................................................----........-----•--•---••-•-------•-•---•-•-•- ....._..-•---------•-•-••-•••••--•----••-•-------•--•-•----•--••-••-•--••--•------•------•-•------------------•----•--•-••---•-------•--.._.....•••---••---••--•-•---•--••--••----•••-------•...•--------•-•-•-......••---•••• -----•-------------------------------••---------------------------•--•...............................---------•------••-••--•---•---•-------•--•----•---••••••••-•••--...........•-•••••••................................. ........................................................ -•••••• --------------- -•-- ------ ----- .....................-•--•••---••--•-•--•-•-•..•-•••••-•••--•-•••••------••••••...........---•--.........----••-- FINAL INSPECT BY:... �° Date------- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 20S West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-89 !M 8'61 ATLAS