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Ust: - 13 X31 � t'_ ---C(_ _._'�-?- ._�___.-. APPLICATION FOR SANITATION PERMIT .. ,y„ Permit No. ........................ i3 .f [Complete in Duplicate) q-1 - it f Date Issued _______________________ --.--- 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 Ordinance No. 549. JOB ADDRESS AND LOCATION,— r Owner's Name = —------------------------------------------ Phone.WY)..... --- --- - Address-----II_-X2--0--- a "' -------------------•-•- - Contractor s Name.. '-1. _..__?~► -- .__ '� -> - •---------•-----•-•-----•------------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1___ Number of bedrooms ._------ Number of baths ...L. Lot size -,S.Z?X'__1_im_______________•--_ Water Supply: Public system PQ Community system ❑ Private ❑ Depth to Water Table 70 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe' , Hardpan ❑ Previous Application Made: (if yes,date--------------------) No EZ New Construction: Yes a No ❑ FHA/VA: Yes ❑ No R T�PE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well___ Distance from foundation----LO__r _____.Material__._n- _ C_ _ ..r................... No. of compartments_.._______V„_______---Size--?-,K...V,,_'�<.&_'Liquid depth------K7.0- -"---capacity.. 4 � Disposal Field: Distance from nearest well--Distance from foundation....1_ ......Distance to nearest lot line....... Number of lines...........r-----------------------Length of each line------- ,_rte......_-------.Width of trench_____3._�.:_Lt..`.'__._...__ Type of filter material._.] ,L1_C:1 ____Depth of filter material------1��-------- Total length.......... D/____________________ (1� Seepage Pit: Distance to nearest well----------------------Distance from foundation__..____-..._...-__.Distance to nearest lot line----._._--_---__• F ❑ Number of pits------------------------Lining material...--------------------Size: Diameter-----------------------Depth----------._._............... .._. R' Cesspool: Distance from nearest well_________________Distance from foundation----.-------.-------Lining material______._....___..._............... El .._ Size: Diameter---------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------._Distance from nearest building_______.---.___________________--____-_. ❑ Distance to nearest lot line----------------------------------------------------------------------------- Remodelingand/or repairing (describe):------ •--------------------••-•--------- -•--••---------•----------------•----•-•-•--•--------- ------••---•------------------------------•---•- ---•--- -- ---•--------•------------------------•----------•-•---------•-••----•--•--•--------------------------------------------------------------------------------------------------------------- --------------- I 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, /ll,� �r� {Signed}.. ' � ,7 r:.. �I� -•----------------------------------------------------------------------------------------------(Owner and/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 i APPLICATION ACCEPTED BY--..j. --- � ---------------------------•--------------- DATE----- •--"., I REVIEWEDBY----------------------------.......... .------. ---------------------------•--------•------- DATE--------- ... BUILDINGPERMIT ISSUED-------------••---- ---._._...----------------------------------------.----------------------------• DATE---•-------------------------------------------•------------- `�-A._.it�eratio_n..s dtif .a . ----- .R.... ._•----- . ................. ---------- ---•-•------- ---------------•-••---- .r� O �� _! ----------- - --- ------------------------------.....---- ------------ -- ' FINALINSPECTION BY:.----- ------ -- ----------------- Date--------------.....------------•-------.-..-•------------------------------ 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 4B 9 REVISED B-89 ZM 8.61 ATLAS /'_