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rUK UN-K-t USt: r ----- 11 __4 --------.Y____._ 7 `- .. ---_.. APPLICATION FOR SANITATION PERMIT Permit No. 1..... �:.: ..___. ------------ ---------- (Complete in Duplicate) \ f Lc �� r-- 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 descrbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION........... - v_:r S3 _ ---------------------- Owner's --• _- Owner's Name----------------1.'7i7RA_1.---• Q-qA" _n -------•--..---- -_-__ Phone.------------------ Address--------- _cL!fit-3 - ---••----•-•.................................................... Contractor's Name..............--•• -•- -*------•----•----------•-- ----- Phone................................... --------------•----•--------------•-- Installation will serve: Resident Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __!.. Number of bedrooms -xY-- Number of baths ________ Lot size -----------�_A_CZ _____________________•--_ U�) Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe`o Hardpan ❑ Previous Application Made: (If yes,date--------------------) No E- New Construction: Yes ❑ Nog, FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5a tic Tank. Distance from nearest well------------_-_.:Distance from foundation--------------------Material_...______-__._ Lah op No, of compartment s----•---------------------Size. ."X--------=--------Liquid depth- ------Capacity 4DIs Field: Distance from nearest well--46 .-Distance from foundation__/,& -------Distance to nearest lot line...... Number of lines--------------/-------------------Length of each line-------C1.4'-'-------------Width of trench-.------- ------------•---- Type of filter ma#erial• <�---Depth of filter material____-/�__----------Total length---_---------__Q-i___..______ ---- Seepage Pit: Distance to nearest "fall----�s�cs}-___Distance foundation____.?kr-___-.Dist nce t nearest lot line -_____.__... 1 - I� Number of pits-------L_-----------Lining material. c►_ -Size: Diameter-___e�_�.--- Depth__-.-_____� .�___..._ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material _._____..__________...______.._.___._ ❑ Size: Diameter----•- -------------------------------Depth------------------------ Li Liquid Ca Capacity P ty-----------------•----------gals. Privy: Distance from nearest well______ Distance from nearest building ❑ Distance to nearest lot line------------------------------------------------- Remodeling and/or repairing (describe):------------------------------------- •---------•-----------•---------•--------••-----------•----••------•----•-----------------------------------•----•--•---•------------------••---------•-----------• ------------•--------••-------------•------------ 1 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) 1 = 3 � -- -------------------------------- -•-------------------- ----- -----------•-------------{Owner end/or Contractor] By:--------------------------------------------------------------------------------------- •-----------------•------------------ 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____ DATE_-. '_----- _- --------------- -- BREV ------------------- IEWED BY-------•--•----------------•---------- DATE-• •--•--•------ UILDING PERMIT ISSUED--------------------------------------- ------------ DATE --- -------------- Alterations and/or recommend'a+ions:------------------ -----------•------------------•-•------------------•------•- ----- - - ------------••---------------••---•-•-•-----------.----- ---------------------- ------------------------------- ------------- -------------------------_-------- ------- T------------------------/------- -------------*.....................*----------------------- FINAL INSPECTION BY:............: �_ _ ----------- Date-----.-- y _ -------••----------- 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 rS 9 REVISED B-89 2M 5-61 ATLAS