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rUK vrrict rG' A- ----- •---•----- -----. - - APPLICATION FOR SANITATION PERMIT Permit No. . .. q �� { ----------------------------------------------------- (Complete in Duplicate) ------------------ ---------_-.------------------ This Permit Expires 1 Year From pate IssueDate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. r This application is made in compliance with County Ordinance No. 549. asp lj JOB ADDRESS AND LOCATION... r •• --------------- ----------G` ,1-1--•-•----Z t I Owner's Name - ------------- ----- ----------------- -------- -----•------------ Phone.................................... �1, ��,oi • Q ---------------------------------- •. Contractor's Name.........5- ------------------------------------------------------- ----------- ----------------------------------- -----•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths-------- Lot size --- Wafer Water Supply: Public system ❑ Community system ❑ Private Up Depth to Water Table ��ft. I Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Gay ❑ AdobeQ Hardpan ❑ Previous Application Made: (If yes,d.ate---------------_----) No ❑ New Construction: Yes ❑ 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- .Distance from foci ndation_. ------Material. � C .a-aC� (� No. of compartments_..__ -__-----_--__Size__3.A-�---- Liquid depth__ ''.�`'�!-_Ca aci Cap ty Disposal Field: Distance from nearest wellaf-Distance from foundation___ ....Distance to nearest lot line._. -,•• Number of lines___________________ ___`'•Length of each line -� - �__!%idth of trench------�_-- Type of filter material._/pp !C _-__Depth of .filter material--____ f --.-Total length-_x Seepage Pit: Distance to nearest well----1,10-'r Distance from fo ndation------.JG�........Distance to nearest lot line.._ _— Number of pits.___.. ___________Lining material---- rte--Size: Diameter__..- -`!- Depth........ � �_. .--------- Cesspool: Distance from nearest well___-_______._-__Distance from foundation-__________________Lining material------------------------------------- Size: Diameter------'-------------------------------Depth------•-------------. ----------------•-----.-----Liquid Capacity.... gals. Privy" Distance from nearest well------------------_________------------_ � Distance from nearest building---------------_ ❑ Distance to nearest lot line.---------------•------•-•---------------- Remodeling and/or repairing (describe):__-_____ _________________ ----•--••--------•----•---------------•----------•-•-• --------- ---------•--------•-------••-------••-----•-------•------------•-------- I hereby certify that.I have prepared this application and that the work will be done in accordance with San Joaquin Coun + ordinances, State.laws, and rules and.regulations of th San Joaquin Local Health District. ty .' 1 r (Signet:14_ ? rr ` . - -----------------------------------------------------...................(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 A 4 APPLICATION ACCEPTED BY------ - ------- -- -------------.----- DATE-- REVIEWED �- 1" -------- ---- REVIEWED BY--------------'.�-•----------------••------ - ------ -•------ - DATE---------------------------•---••---------•----- - --- BUILDING PERMIT ISSUED--------------••-• ----------__-_-•_ - DATE Alterations and/or recomn dations: -- �P__`-. ��. .. �' ---- ---ry - •- -----I--------------- ------•--- - c -- r'^•---------- f ---------••------••----------------•-•------••------.-•— fr ----- `, f FINAL INSPECTION BY:-.-.J- .-- r. - Lam, Date--- SAN JOAQUIN LOCAL HEALTH DISTRICTS 130 South American Street 300 West Oak Street 124 Sycamore Street ZOS West 91h Street Stockton,California f Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.89 8M 5-61 ATLAS