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-------- --r . -------- _.,A I 4_:�0 APPLICATION FOR SANITATION PERMIT Permit No. . --------------------------------------------------- ---- (Complete in Duplicate) -------------------- t 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. This application is made in compliance with County Ordinanc o. 549�� d JOB ADDRESS AND /A.Tl N___ __ -Q.-Q� _ --, _ #- -------------•- -----••-----•-•--•....... ------------ Owner's Name ---------- Phone.-..-•------•-------•-------•------- AddreSS.................................... .. ............. ------ •-------------------- ------..............'---------------_------•---------- �.... pp% Contractor's Name - .---- -- --- -- ----- ---- - --------------------------------...........__ Phone7C:��:. Installation will serve: Residence Apartment±House E:] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____ Number of.bedrooms ---a. Number of baths J. Lot size ---->�O'�3®o/.......:............... Water Supply: Public system P<Community system ❑ Private ❑ Depth to Water Table T-,o ft. Character of soil to a depth of Meet. Sand ❑ `Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan❑ Previous Application Made: {If yes,date--------------------) No ❑ New Construction: Yes ❑ NoFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ( o septic tank or cesspool permitted if public sewer is available within 200 feet.) e i nk^ Distance from nearest well______-----------'Distance from foundation--------------------Material.___________---._______--------....__--_-----.-.- No. of compartments------ -------------------Size.------------------------------Liquid depth----------------------....Capacity-----------......------ `sal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line................. Number of lines_-.'.-------------------------------Length of each line------------------------------Width of trench......................-----._--...- Type of filter material_________________________Depth of filter material____..____.__________..Total length...________..........._______..__...______ I � � See�pa.,/ge �t: Distance to nearest well ___ __Distance f fo ation..42:6_........Distanip to nearest lot line___.__.:_ 921 Number of pits----��_.________-.Lining material___ - Size: Diameter__3.3 -- 1 Depth_ Distance from nearest well...._________.-_Distance from foundation__.-.•_____________Lining material_-____..___________..___.._____.....: Cesspool: ❑ Size: Diameter----• --• -----------------------------De th---------------------. --_-_-------- -Li Liquid Capacity gals. Depth q P fY Privy: Distance from nearest well------_------------------------------------------Distance from nearest building_____._____..___________--_-_-__-___-____. ❑ Distance to nearest lot line------------------"_-:!t=----- -----------"'. - - = Remodeling and/or repairing (describe): ------------------------------------------------------- 1 0 V ------•-------------------•----•---- ------------------------------------------------•---•--------•------•--•---•-•. ------------------------------------------------------------------------------•------------- ----- I hereby rti y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc t aws, en� r s and'�ula of the San Joaquin Local Health District. (Signed)-=- •----- -------- --- wrier and/or Contractor) ----------------------------------------- f (Plot plan, showing size f lot, location of sys+e relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....... __i.___--- -. REVIEWED BY--•----------- ---------•----------•----I---- - ----- ------ ------------------------•------------------ DATE BUILDING PERMIT ISSUED_---_------- I----------------------------------------------------------------------------•--.-. DATE. Alterations and/or reeommen atio _ --------- - ---- - ------- _y------ ---..----------------------------------------------------------------------- ._....- ------ FINAL INSPECTION BY: - ----------- Date-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strout 124 Sycamore Street 205 West 911%strut Stockton,California �' Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-$9 ZM 6-61 ATLAS