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FOR OFF)CE USE: s ---------------------- _-----____`. APPLICATION FOR SANITATION PERMIT Permit No. ---------------.-- ---------- --------------------------- ._----....� ------------ (Complete in Duplicate) f/I Date Issued .---•--• ------------------ --------- ----------------------- --- --- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliancewith Co ty Ordinance No. 544. JOB ADDRESS A D LOCATI Owner's Name------ -�''.. -.- -Q.. . .�_C__. '-------------------------------------------------------- Address-------�... ..=...-- � h_�-L'_ _.�2 --------- -• `�o-4&__.,�- 2J.e_-•------------------ ... •--•-•-- Contractor's Name_ _-f - _:�t�--C41 --- ---1 -- i��---`h� -- yG ______________ Phone..;Il...- Installation will serve: Residence eq A"artment House Commercial Trailer Court Motel Other Number of living units: J__- Number of bedrooms -- ---- Number of baths .1--- Lot size ....... ........... Water Supply: Public system ❑ 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❑ Hardpan ❑ Ptevious Application Made: (If yes,date--------------------) No_;!�_ New Construction: Yes ❑ No FHANA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i S, ti Tank: Distance from nearest well,-O., -Distance from foundation_____-/___-------- Material .... I No. of compartments ` 7, r P 2-----------------Size.SZ_"K �_��. ��Liquld depth------, �_'_____ _Capacity._..___ .__.? r - Di spo al Field: Distance from nearest well__e _©._ .-.._Distance from foundation..___�a_r.___.Distance to nearest"rlot line------- r Number of lines--------I------------------ -•_--Length of each line------(6--©--f-------------Width of trench'_ :-cz ---------•-•--- y Type of filter materlal �. ___ .____Depth of filter material______1�'___----TatallengtE$_. ___t______.___.___.__ I _ ,. 4 f I Seepage Pit: Distance to nearest well-�i2� -----Distance from foundation-/..0-0r,__..Distance to nearest rot line___ __ ______ A�kp I--------------- mate Diameter'-.911111111111k. _- , _-._ p� p Number of pits 3 -------.De Depth -•---------=------------- Cesspool: Distance from nearest well.................Distance from foundation__._________-_.___.Linin`rmaterial__________"_�______-_________ � ❑ Size: Diameter--------------------------------------Depth--••-------------=---------------------------------Liquid Capacity ----•---'i•- ------------.gals. r-•- + Privy: Distance from nearest well--------------------------------------------s---Distance from nearest 6uildincj___»___..______._._.._.....___._.___.._... i ❑ Distance to nearest lot ii ____ t p` P Remodeling and/or repairing (describ - ----- --- ------- __ _ _«_ ----- ------------------- -•---•--•-•------------- �Q•G•--.a----_- -----'.._ -_.-.--_.•.-_--_-.-..----..--•--------_ --. - ---------------••-•----- ----•--------•••---------------------------------------------•--•------------.-..------------------------------------------------------•-------•---------------------------------------------------- I hereby certify that I ha a prepared this application and that the work will-be done in accordance with San Joaquin County 1 ordinances, States, a r les and regulations of the San Joaquin Loce Health District. r'" (Signed) -• -- -- ` x ._..... A - ''.`""c ` J r Contractor) By:........................------------------------------ --•-••-••--. ......... ---•-•---------(Title)--------------------------------- ........... -------- (Plot plan. showing size of lot, location of system in rely n to wells, 6uildKgs,letc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ILSs-i---------- =------------------------------------- DATE------/°L _ .1�_.G--�=---------------- REVIEWEDBY-----------------------------------=---------------------------------------------------------------------------------------- DATE---------------------------------------------_....... BUILDING PERMIT ISSUED-------------------..........------------------------------_11!----------------------------------- DATE------------------------------------------------------------- Alterations and/ reco mendations:0"4.,:: -•.. .'= ��"` ---- --- -- ----- -------- -- - - - ---=----- --------------------------------------------------------- ------- � ....... ------•------------------------------------- -------------------------- ----------------------------------------_-.--_..---_--.--------..------------------------------------------- ------------------------------- FINAL --------------------------- --FINAL INSPECTION BY:. . ------ ---- ---- - ------•-•-•- Date--------� ---� = ; -------------------------•--•-••-- �,-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED 9.59 SEM 5-61 ATLAS - 7i