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PUK UFrIC.E USE: ------------ -------------------------------------------- ......... -------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. :. l (Complete in Duplicate) IJ ..-.. ------!_ _� ----------------------- --------------- This Permit Expires 1 Year From Date Issued Date Issued !- 3fo_.,Z Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta the work herein described. This application is made in compliance with County Ordinance No. 549. T 27f p' N. S ccJs;E STS . JOB'ADDRESS AND LOCATION._ -�t1• � .--- Owiner's Name .._.--{A .. •- --• 7 Phone-•-------•- :...L Address------ ----- - �- ----------••---•------ - Contractor's Name.... �! Phone...... ••--------------• ---••------------ •--••- . Installation will serve: Residence ❑ Apartment Ouse ❑ Commercial df Trailer Court ❑ Motel ❑ Other ❑ I ': Number of living units: ._ Number of bedrooms -------- Number of baths ........ Lot size ......5�._K _?S d Waiter Supply: Public system ❑ Community system I Private ❑ Depth to Water Table ........ 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 ❑ New Construction: Yes Aj 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 �+ istance from nearest well_-_--------._-._Distance from foundation--------------------Material-----------------,................ kiNo. of compartments---------------- '--:o.-Size---------------------•--••----Liquid depth---.------------- CapecitY ..--••---••f---- N Disposal Field: Distance from nearest well..... ,f-..-Distance from foundation----_L©--_.__..Distance to nearest lot line.... ........ } I ( Number of lines---•-------- ----------- ----"`'•Le..ngth --- .. Lfs-._-----.Width of french each line------ -Type of filter material._.. ----Depthof filter material------/.,7----------- Total length-----------e�d---- •-•-i- -•-•-•--------•- Seepage Pit: Distance to nearest well----------------------Distance from foundation_........_ Distance to nearest lot line................. laNumber of pits----------------------Lining material:.�:---------------Size: Diameter--------..------- --_.Depth-------..----__------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------..___.Lining material_.------. ❑t Size: Diameter. ----------------------- Depth -- a ------Liquid Capacity----------------------_--- Privy: Distance from nearest well---------------____-_-------------`-'---------Distance from nearest building.--_----__...---___-.-..___.----•••__--� �p i❑ i Distance to nearest lot line-------- ` = �4 --------------••---------------------•--------------------------' Re�mlodeling and/or repairing' (describe):-- -_-----,• ---� o ---- �� t - ",'' Vic... -------------• -------...-----------------..------ -• •------ F K.. ----••--••------------=�------------- li . 4. ------------------------------------------------ •-----•- :=t 4 ----------- - ' I�I hereby certify that I have prepared this application and that the work will be done_in.accordance-wifh_San Joaquin County ordinances, State laws, and rales and regulations of the San Joaquin Local Health District, i (Signed)----- - ----.:-a/1 `'`r �^, ; -L --- - - -----_--•------'--------•--- ----- { .. or Contractor) - ` _r �` c t...---------:(Title) �.- (Plot plan, showing size of lot, location o system in relation to wells, buildings,°etc., can be placed on reverse side). s•, a i :--1.R j-FOR-DEPARTMENT USE-ONLY s APPLICATION ACCEPTED BY DATE � 1__ lc.'� REVIEWED BY ------•------ DATE.. BUILDING PERMIT ISSUED----I Alterations and/or recommendations:: ` t- ' �...1.. --------------------------'-.---- :_.... :..... •--- - -= ` ---- ----- ..--- •-- " -- -- 1. 1. } ' ------_---- II ......•---•..........................•.......-----•--- ----- , ----------------------------------- -••----------------- ------•-•--- _ —FINAL INSPECTION :BY.�-- = a _...2 Date------- ,,. € SAN JOAQUIN LOCAL HEALTH DISTRICT la 130 South American Street 300 Wesl oak Slreel { 124 Sycamore Striet 205 West 9th Street Stockton,CaliforniaLo � di,California 4� ,Californiaonteca { Tracy,California . i- i . Jr55s E6 9 REVi6EC 6-69 21x1 5-61 ATLAS lf�!� f��