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FOROFFICE SE ----- ----------- ------r-.1/..o APPLICATION FOR SANITATION PERMIT Permit No. _13 - r.. (Complete in Duplicate) ---------------- This Permit Ex ires 1 Year From Date Issued Date Issued __..... ....�� Application is hereby made to the San Joaquin Local Health District for a permit to construct and ;n all the work herein described. This application is made in compliance with County Ordinance No. 549. /40031a . , JOB ADDRESS AND LOCATION '------------------••----------- GAS --••-• .... Owner's Name._��.�Y..�'"�T +Y� ��! . . . -------•-• t '2" - ------------------------ ----------- Phone. ...... Address_ ...... �_..- Contractor's Name------- .. .................. a ��e5� E Installation will serve: Residence ❑ Apartment House [:] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /.__ Number of bedrooms _��'`- Number of baths /.... Lot size -_ ______________________ Water Supply: Publics stem r �� y ❑ Community system ❑ Private � Depth to Water Table ..______ ft. Character of soil to a depth of 3 fee': Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[- Hardpan ❑ Previous Application Made: (If yes,date--------------------) No'[-] New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ v TYPE OF INSTALLATION AND SPECIFICATIONS: \ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we -Distance from foundation_-1 !_-_.Material/ dam ------.Size=: - Li uid de th_. fI � � Pt No, of compartments_.--_ ,.�_____ q p• f_-_Ca aci � -_ pisposal Field: Distance from nearest well DIstance from foundation__ d _- Dis ante to nearest lot line-____ I_- 14 Number of lines-.______....._ �G�_____Length of each line_��.-�� hof trench------ Type Type of filter mater;aL1�____-------_______Depth of filter material_.. _ __ Total length----- .__�[�!___.-- F Seepage Pit: Distance to nearest well___00__._` Distance from fpundation______�_ J..._...Distance to nearest lot line . Number of pits--- ------------Lining material____ -___ .,,.-Size: Diameter_ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- El _____-•___.___-_------._._❑ Size: Diameter- "--------------------------------Depth----------••-------------------------- -------------Liquid Capacity------••----•-----------_-gals. 4 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-__------______-.....___ Distance to nearest lot line------------- ----------------- Remodeling -------------•-Remodeling and/or repairing (describe):--------:---------•--------------------------------•-------------------•-•-•-•----- s --------• --------------------•----•-------------•--•----- ---------------------------------------------------------------- ------------•---••--------- ---------------••----------•-- I 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._ the San Joaquin Loqal Health District. , (Signed)• f ..... . ..-z---- - _---------------------------------------(Owner and/or Contractor) By:....-•....--•----••---•-•------••-•-••-••----I------------------ --------------------------------------------------•............(Title) = (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR D PARTMENT USE ONLY APPLICATION ACCEPTED By------- DATE__ REVIEWEDBY-------•---------- •------------ --------•------------------- DATE ---------------------- BUILDING PERMIT ISSUED-------------- t -- ------ ------------------......------------------------ DATE----------- - Alterations and/or recom�enct�afions:----- _ _ __-- ---.-_ 1 ------------------------------------------- ------- ----------------....------------------ ---------------- ------•----------- FINAL INSPECTION BY:r.....2 -- = ----------- Date----- ----------------------------- -$AN --- ---- USAN JOAQUIN LOCAL"HEALTH .DISTRICT 130 South American Street �� 300 West Oak Srnet 124 Sycamore Street 305 West 9th.Slrsat` I -Siockton,California ( Lodi,California Manteca,California Tracy,Caiifernio ES 9 REVISED 8.89 EM 5-61 ATLAS