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FOR OFFICE USE- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..;.../___ .._.._.__ ---- --------- -------------------------------------- (Complete in Duplicate) Date issued _��/:Y'�-- ?% ` _________________________..._..._..-.-_.___.__..._ This Permit Expires 1 Year From Date Issued pSl 37 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance_with County Ordinance No. 549. JO QDRES AN � D LocATION .;�* 1�----- r'` --•- , le .. Owner's Name--- fP ........ Phone------------------------•--•--•--- Address---- ---•-•-•------•---• •-----------•....................... Q_ :d -- f�'1�� .............. .................?......--- ----------- Contractor's Name. - ..........--••--------------------------------------------------------------------------------------.---------------- Phone..........................-------- Installation will serve: Residence. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑sqy Number of living units: __1____ Number of bedrooms . --- Number of baths ._k._ Lot size Water Supply: Public system ❑ Commuriity system ❑ Private 12� Depth to Water Table �?.0. ft. 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy t oam ❑ Clay Loam R Clay ❑ Adobe❑ Hardpan l{ Previous Application Made: (If yes,dote---------- - ----) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ ( I t � F TYPEOF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet:) — -- -� -; Septic Tank: Distance from nearest well_rp_.......Distance from'foundation---A`.......Material______ ____________•__.- No. of compartments---- y_____�__..____Size_ !- ------$___Liquid depth__.-_ ------------------Capacity.,l! '. .. .. Disposal Field: Distance from nearest well 'Q---------Distance from found0� ation. ___________Disfante to nearest lot line...__._._. 3 Number of lines-__._.,'eL._..... .._ Length of each line,./10-0-------------------Width offrench.....��E."-___._--_-____--_ Type of filter material 4 _Depth of filter material-_e"----------Total length__. __—___________________________ fir-""°�-4 � Seepage Pit: Distance to nearest we l-_74�0_-_._._,._.Di^Sfance fromr undafion_j ............Distance�to nearest lot line-1.6-7'..... T #401 Number of pits-----.Z--_____---__Lining material, OP ----.Size: Diameter___, ----------- _s�_�_..._... Cesspool: Distance from nearest well_________________Distance from foundation---.----------_.----.Lining material----_---____--------__--_---------_-_ ❑ Size: Diameter-------------------------------------- pth--------------------------------------------------.._Liquid Capacity...........•-••-------------gals. (� Privy: Distance from nearest well-------------"----------------------_______`Distance from nearest building____-_.________________________-__-_--__ \`� ❑ Distance to nearest lot line----------------------------------------------- -----......__._..._...-•-----•-------•-----------•---•---------------------------------------- Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------•-----------------------•-------------------- . .......-•------- - ----------•---•--------------------------------•-••----•------------------------------•-------------------------------•--•..................--------------------------------------------------------- ---------------------------------------------------------------.-------•-•-----------.---------•--------------.-------------------------------.-.----.--------.-.---.-------------------------•---•--------------------------- --------•--------------- ---------------------• -----•-----------------•-----------•------.............------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and +hat 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. -- r ---------------•-••------------------•-------------(Owner and/or Contractor) �� - -- �.. = (fi+le) ---------------------- - ------ —.4. (Plot plan, showing size of lot, location of system n relation to"wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 4. APPLICATION ACCEPTED BY-- s `-------------- -----------•-----------•---------------- DATE-_Y_'_.Z - �--------------------------- REVIEWEDBY....................... ---------------------------------------------------------•---------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------t .. ....._.._.__ DATE------------------------------------------------------------- Alterations and/or recommendations----------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- li ---.-•----•------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------------------------------------ ---------------- •-------------------------------------------------------- ------- ....... ----------•------------------------------------------------------------------------ -----•-----•--------------------------------------------------------------------------- CTION / _ FINAL INSPE � -------------- Y ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stroot 124 Sycamore Street 205 West 91h Street t Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVI6E0 e•89 2M 5-5I ATLAS