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------------- - -- -------------------_---_--------_---- _ _ _ - _---------------- ---- ----- ---- --- ---- -- ArIhLICATlON FO' SANITATION PERIvfI`T Permit No. _— (Complete in Duplicate) This Permit Ex fires ] Year From Date issued Application is hereby / Date Issued --- made to the San Joaquin Local Health District for a permit to consinstall the work herein described. This application is made in compliance with County Ordinance No. 549. truct JOB ADDRESS AND LOCATION?_ •_-._ - Owner's Name--.--,/ Address.- ----•------- ----- - - Phone-_---•------------_-----••---- Contractor'sName �' --•--•-----••- Installation will serve: Residence _ ----••-----•----- Phone-----------------------•------.. . Apartment House ❑ Commercial • Number of livingunits: _ -_ Trailer Court ❑ Motel ❑ Other [] -- Number of bedrooms �--_ Number of baths Water Supply: Publics stem Lot size .---,�.-rtit. Y ❑ Community system p ❑ Priva�e� .Depth ro Water Table •f--�_ ft. � Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ ClayLoam ". . Previous Application Made: (if yes,date-------------- �] Clay ❑ Adobe❑ Hardpan TYPE OF INSTALLATION AND'5PECIFICATlONS: l No New Construction: Yes EM No ❑ FHA/VA: Yes ❑ No ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__4 �__-- Distance from foundation_--1p.:__"_____.Material- ?Yr!u Cl I1 No. of compartments- 3._ 3 t - ---- ----Liquid depth---- Disposal Field: Distance from nearest well-�a_'__----Distance {rom foundation. _ld- -----------Capacity.�_�-•--- _ I� Number of lines----_ --------------------------- _____----------- - --- ---••-•-----_--Distance to nearer I t Iine.C'____•-_-- Length of each line___-� _'--_•----_-- Width of trench-.- Type of filter materia _ �-�_.`.--..---" !�'� Depth of filter material_-_-df__'__ ---- -Total length----'-.'7 ShOgPit. Distance to nearest well---,�_:Q---------_Distance from foundation_-_--bV--------- IU Number of pits.-.-- f-__-_ Distance to nearest lot line--- =---------- -------Lining material. 4----------.Size: Diameter---��0.------.Depfih-----1•_Q-•---•--•------ Cesspool: Distance from nearest well Distance from foundation--------------------Lining material............................. Size: Diameter------"-__-�_____________----- -------- ----- PrivY: Distance from nearest well-."-.r.=-_- : - q Capacity-. -- gait--`-� --------------------Dir#ante from nearest bui!ding-------•---------_-----_ .---, Cl Distance to nearest lot line_.-__-.--.-�--r�_____--_-_ ---------------------•-------•----- - - ----------------------------------- Rem �1 Remodeling and/or repairing (describe)----------------------- 1 l • 6 ------------------------- If --------- •--- ---------=---•--------•---------------------•-------•-------------.....------------------•----•---------•---------- ------------•-----•---••---"--•------------------•--------.---, _= 1 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}. Z!?� = ----- ------- VZ ---(Owner and/or Contractor) (Plot pian, showing size of lot, location of system in relation to wells buildings, etc., can be placed on reverse side-- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --. - - - - -- .zc `' _ DATE-.. �. ................................ REVIEWED BY -----•-••----•--------- •------•---- DATE BUILDING PERMIT ISSUED-------------- - DATE Alterations and/or recommend'ations:---__._-.-"".---..- ---------------------•-------•- -- ---- FINAL INSPECTION BY:.. ----------------- Date--Z—J6- �6.3- --------------- ------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 South American Stud 300 West Oak srrq@r 124 Sycamore Street [ 205 Wert 9th Street Stockton,California Lodi,California. Manteca,California } Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS L,