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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ........................ ------------------------------------------ (Complete in Duplicate) 7 2-- Date-.: ------------ - � This Permit Expires i Year From Date Issued Issued ...�.. Appliaation,is hereby made to the'San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatici:is.made in compliance with County Ordinance No. 549. I JOB ADDRESS AND LOCAT ON___ _ - ----------------------- -•-- Phone............. --.............•---• r Owner's Name ..---- t el / Address - A . A`7._•�-.�gy...."-�l-i-7-- -------•--------•--••-------•--•---------••••---•-•----•-•-•........----•--•--•.................•-••------_.... Contractor's Name-- . . ----_ - --__ �� '��---- 'tel'. A_ ------aa................--------------------------------------- Phone................................... Installation will serve: Residence (N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of sliving units: A..... Number of bedrooms __3____ Number of baths Lot size Water Supply: Public syste"' ❑ Community system ❑ Private pfl Depth to Water Table X.P. ft. Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam)@ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Q Previous Application Made: {if yes,date---,------- 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__SD.______ Distance from foundation-__-1 a__._.._...Material__. E•........................... I No: of col npartments _ Size__ "t Y_�'__f' �.Liquid de th____'J7________________Ca aci ./.�� ._.... q P. P tY -------- - Disposal Field: Distance.from nearest well.57_-------.-Distance from foundation__"--.¢'---------Distance to nearest lot line---$a...... Number;of lines__________ ___________ _JJ Length of each line------ of trench.___ !r'`_____._.......__..._ Type of filter material _ L -.Depth of,fiiter,mater.iaL___. ------.____.___Total length_____°tfo______________________________ r -- - - Seepage Pit: Distance'to nearest well__._._---_•_________Distance from foundation___-__'------------Distance to nearest lot line_______________ El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- I � 4 Cesspool. Distance from nearest well.................Distance from foundation_____.;_____.__.____.Lining material..__._____.________--_••----••----_-_ ❑ Size: Diameter--------------------------------------Depth.-=--7---I-------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well _______________---------------'""'--lill1i6- -Distance from nearest building------------.............................. ❑ Distance to nearest lot line-------------- ---------------------------A--------------••---•------•------------------------------------••---------------------------- , Remodeling and/or repairing (describe):-- - --- --- ---- ----•• -y-- -------•------- �--•-- -------- -----•---•-•----------------•=•------•---••---• - -------- - -----•--------- --- ------- ----------------------------------------------------------------- 4 � 5 ------------------------------------------------------- -------------------------------------------------------- --------------------------------------- 1 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 regulatio`ns-of tke'Sanr'Jaequin Local Health District. Si ned -----------•T----------- ---------------------(Owner and/or Contractor) �.•s,.f B _ (Title)---------------------------------------- ----------------- Y• --------------------••----------- ; (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 i APPLICATION ACCEPTED.BY ,;,--------------------- --------------------------------------- DATE__-_-------=G---------------------- •------- ----------- REVIEWEDBY----------------------------------------------------------------- ---------------------------------------- :7...... DATE-------------•--------------------••--------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------.......------------'---.._- DATE-------------------------•--------------------•------------- Alterationsand/or recommendations:---------------------------------- --- -------------------------------••-------------------------------------------------...................................... ..:..........------------------------------------'------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------•----•-------------•--------•--------------------•-----------•-- --•--------------•-- -----------•............................ ---------------._.....----•------•-------------------------------------•-- FINAL INSPECTION BY: -, t Date / --~---------- ----------------------------------- f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ii'51 REVISEE) S-B9 pM 6-6[ ATLAS t