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------------------------------------------------------- r' / -------------------------------------_---..--_-__--.-.-. APPLICATION FOR SANITATION PERMIT Permit No. _1_/ f6). -------------------------------------------------- (Complete in Duplicate) ------- 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 ibed. This application is made in compliance with ounty Ordinan No. 549. , JOB ADDRESS AND CATI N-- ; --• -•-••-.. •---•-------•........ Owner's Name ..... �... �..-•----.-. Phone.-.................................... Address..__ :�------- -, -�y - ---- --•--- __ Contractor's Name----...........�.---_�fZ?---•--- •- ----._ _ + - -- •-------- ---------•---------------------.._.....-------------- Phone................................. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----/__ Number of bedrooms —3-- Number of baths -- Lot size ............. _��. _ �4 ----_ Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table . - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan r Previous Application Made: (If yes,date--------------------) No &( New Construction: Yevo No ❑ FHA/VA; Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_ 0049 Dista�ce from foundati n_,�.�- --.....Mater- I :. No. of compartments_.-----'� _-------Size-_..e.. Q igdid depth------------ - --- '- apacity.__j_ UG2`f' Disposal Field: Distance from nearest well.. .-0627-Distance from fo dation--- rJ- --1 _.Dist n e to nearest lot line Number of lines------- .----r----_---- _Length of each linea. ' "Ix ..(�� of trench.-_--,�-�r_1_� Type of filter material._._(-}SCh-Depth of filter material----� -_�__-...Total length------...E.. ,!?................. .... Seepage Pit: Distance to nearest well----------- -----------Distance from foundation....................Distance to nearest lot line................_ 9: ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.---._.-----------_- Depth---------------.................. Cesspool: Distance from nearest well-----------------Distance from foundation--------------.---..Lining material---------------_...........El ! Size: Diameter--------------------------------------Depth----------------------•-----------------------------Liquid Capacity.--------_------• - --•9als. rivy: Distance from nearest well--- ----------------------"""_Distance from nearest building-------...-_----__-.___---. ------------- Distance to nearest lot line-------------------------•-------------------------•-•--------- Remodeiing and/or repairing (describe):-- -_ ,_ - --�---942-- Q — _ hr --- ----•-------------•----------•----------...----••------•-•----•------------•-•--------••--------•------------...--------••---------•-------------•---------- �e 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. (Signed)----------------------------------------------------------------------- ------------------------- ----------------------(Owner and/or Contractorl ! 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 f APPLICATION ACCEPTED BY------------- ----------------------- --- ------- •- DATE - REVIEWED BY--------------------------------------------- ----• - ---- --- ---------------- DATE---•- -- -� BUILDING PERMIT ISSUED----------------------------------- DATE ------ Atterations and/or recommendations:------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- -_______.•--_ ---------------------------•-----------•--...-----...-..------------------------------••---- FINAL INSPECTION BY:.-------- ------ ------ --- ""' ------- Date-----------------/ � — (r. 2_� ;--- -------- --------------------------•----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamor*Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED 0.59 RM 6-6[ ATLAS ft ►oma=f