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FOROFFICE USE . ..{ f -------------------- ------------------------------ APPLICATION F6R SANITATION PERMIT Permit No. _._l...../ ../... - ----------------- ------- '---------------------•---- (Complete in Duplicate) ------------------------ This Permit Expires 1 Year From Date tissued 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'LOC 10, .�,: f 1. �'- ---- ---- g .. . -.�..-� Owner's Name----- r ✓ ---Y- -----------•------------ ------------------------------ Address________________ i Contractor's Name................. - - ----- .-•----•-------••-=-------------------------------------------.-•------•-•-•----\ Phone.................................. Installation will serve: Residence° ®�partm'ent House E] Commercial ❑ Trailer Court [IMo el [j ;Other ❑ Number of living units: -f Number of bedrooms __.� Number of baths __ =_ Lot size-�_�.`�f�_. =_,� ----------------- Water Supply: Public system I i i ppy• y ❑ Community system ❑ Private Depth to'Water Table _ dit. Character of soil to a depth of 3 feet: Send,Ej Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes date_ _J. No Zi! New Construction: Yes No �FHA/VA: Yes ❑ No R— TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitte .2if-public sewer is available witiiin 200 feet.) I '"� Septic Tank.-,, Distance from nearest well-----------------Distance from foundation•:!._ ....._._.1_ _.Material_:_--....-__1................................... y. "JI&I No: of compartments- ` =-----------Size---�� -------•-- ---#!quid depth----------------- `-Capacity € r� i Disposal Field- Distance from nearest 11--- -----------Distance from foundation---------------1...Distance tamnearest lot line................. Number of lines.............�-_----------}_`___,L_ength of each line��-------------------�_-•.Width of trench................................... J .� s P g Type of filter rriatenal._._-----J----------------' Deptk of filter material� ----------- .------#--.Total length....-�-----------........................ ; .. f� See a e PI+: Distance to nearest well____. _.______Distance f m foundation__ ..'_:.Dista ce_fo-nearest lot Ii�__ .......... Number of pit s...J--------------Lining material___ �i_-__-.Size: Diamete ..............Depth----/P-.............-------- Cesspool: Distance from nearest well.................Distance from foundation---------...........Lining material.:..................... (,d El Size: Diameter---------------------------------------Depth---------------------------------------------------Liquid Ca act --77 -_,gals. Privy: Distance from. nearest well-------------------------------------------------Distance from nearest building.--......___________-_---.-.._.` ❑ Distance to nearest lot line---------- --------------------------------------------------------------------------- --------•............•------------------------------------•---••-----••-------•-;` ------ \ �`kap• Remodeling and/or repairing (describe):---------------- = .---------•--•------------------ j [ . f -----------------------------------------------------r---__.-_-,_-_-.�_---_ter!--_�----------------- ----------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this applicafion and-the+the wa k will be done in accordance with San Joaquin County`}-l) ordinances, State laws, and rulos and re ula+ions of the San Joaquin Local Health District. I ,��, (Signed)------------- _t••'! 70 ' ----------- { s!/or Contractor] BY----------------------------------•.=--...----------------�mi - ..................(Title)- t l ':'--•------ --------r----------- (Plot plan,fshowing size of lot, location of sylation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... - --------------------------•-----•----------- DATE--------- -------------------------- . REVIEWEDBY__._... ----- -------------------------------------------- ---- DATE...----------------------------- BUILDING PERMIT ISSUED------------_------- ------------------------------------------------------------------------ DATE------------------------------------ gn�/or recomm , ndations:-•-•------•---- •-------------------------------------•-----------------•----------..._.._.....--•----•----...............---•--....--------•--•--••------.... . .---- ----------------- ... -_ -4------------------------------------------------------------------------ ---------------=--- FINAL INSPECTION Bh`w- ---- -------- -------- -•----- •-------- :.,,,,.-.Date-------�// J - ----------- �- SAN JOAQU]N`LOCAL HEALTH0STRICT 130 South American street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California - �,� w-•YY\.Lodi,California Manteca,California Tracy,California ES 9 REVISED B-89 2M 8-61 ATLAS v