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FOR OFFICE USE: Permit No. ..�:+�•--s----• " .� 7 41 El;ca APPLICATION FOR SANITATION PERMIT ----------------------------------- 1 ------- (Complete in Duplicate) Date Issued .!`.t ---�� 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 Ordinan49• (/p!r Q yy ....... -- JOB ADDRESS AN LO N - ............ ---- - � Phone------------------------------------ .......... Owners Name_ Address..... f90-- --------- ----- ----------------------. Phon . - Contractor's Name------•......------------ ------- --- ......... 1 Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` f _ .� ---•••••• Number of living units: .4 Number of bedrooms .c.�-_ Number of baths _ -_ Lot size ..... ... ... Water Supply: Public system grotommunity system ❑ Private ❑ Depth to Water Table Z& ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2"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.) Lfit53n, Distance from nearest well_-_-_-"-_- ---__Distance from foundation---------------_--.Materiai -."---__--------.•••----•-••••---•----• Liquid depfih-------------•.-----------Ca aciNo. of compartments-------- --------------Size-------------------------- ---- p tY--•---••------ispoDistance from neare�t weel ----Distance from foundation.-/Q.•--......Distance to nearest lot line...-_ ..... Number of lines._- --_------- -.---------Length of each line---_---__��y;-----.Width of trench.._-__� .----------------- 9310, Type of filter material-Z___R,e/�"..--Depth of filter material-.--/ -------_-Total length_-_____3d_•.__-.--------- ------ $�f9enclation-.J4 w� - i Seepage t: Distance to nearest well-1l.OY� _Distan .�_____.Distance,to nearest lot line-�-------------- Linin materiaSize: Diameter-_"2_�..--"----Depth----�sS-----------------• Number of pits---- --------- g � Cesspool: Distance from nearest well------------- Distance from foundation.-.------_------"--.Lining material--.-._---_-_-_---.•---•-- als. O 171 Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity--------------------- 9 Privy: Distance from nearest well---.-----_-_-"--------------------------------"-Distance from nearest building------------------------------------------ ❑ ...... Distance to nearest lot line------------------------------------------------------------- Remodeling and/or repairing (describe)------------------------- ---------------••--------------------------------------- - ••----------------------- ---------------------------------------------------------------•------- --------------------------•-------------------------County I hereb c that I have prepared this application and that the work will be done in accordance with San-Joaquin ordinan e , ate I s, and`u s and reg u tions of the San Joaquin Local Health District, r O r and/or Contractor) (Signed) ¢---- - By.................................................... ------ (Title) --------a (Plot plan, showing size of lot, location of system in relation to Is, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---- ---.,"' `'~------------------------------------------------- ------__ DATE----- l G REVIEWED BY--------------------------------- ---------- -------------------=-------- ----------- ------------------------------•------- DATE------_-------------------.----------------------------- BUILDING PERMIT ISSUED------------------------- ----------- DA•TE------------------------------------------------------------ Alterations and/or recommendations:---------------------------------------------------------...-.......................................................-.....................I----------- - -------------•--------------------•---- --• ----------------------------------------------------- - ------------- --------------------•------ -- - FINAt INSPECTION BY:-"-"- Date.--------- �P -----------------•----- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Slreet 300 West Oak Street 124 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 14EVISEO B-59 2M 5-61 ATLAS F