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-� UKcyr% Gt/ .- ------- - APPLICATION FOR SANITATION PERMIT Permit No. ...,! ------------------------------------- - --------------- (Complete in Duplicate) /J Date issued ----------------- This Permit Expires 1 Year From Date Issued ._.../}1-�._� 7✓� 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. �-. JOB ADDRESS AND LO ATION-_ ._--�--_�-�:? '7 7 ............................................... OwnerOwner's 's Name ------ :� ------------------•---------•----••----------••--•--- ------------------------------------------- Address ---------------------------------- .-._ ...- Address----- --=------ --•--------- •-------••-----------------------------•-•- • _-- ,�J-- - - - - -------•------------.......---•-•--•--------••- `� Contractor's Name...-----`--.. ............... - .�...`...D D------- ------------•-----•--••---... Phone................................... W --•----- Installation will serve: Residence aEr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I.._ Number of bedrooms .-T- Number of baths __J.-.. Lot size -l-_b�`��_`�' ________________ Water Supply: Public system ❑ Community system ❑ Private &-Depth to Water Table'? ft. , Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam0Ciay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No E ' New Construction: Yes ErNo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S,- ank: Distance from nearest well--_5---j4�----Distance from foundation---1.r---------Material--------------------------------------------- No. of compartments------- ------------Size.t?_IN__---.--•Liquid depth......�.-----------Capacity.... � Disposal Field: Distance from nearest well-, - -----Distance from foundation- �-L--..----Distance to nearest lot Number of lines---------- ---------------- Length of each line-_--Len _- J -- g --•--- __•-•Width of trench--------....� Type of filter material__.t e� -.Depth of filter material----.IX'-__-_-.-Total length...........9`_D----------------------- Seepage Pit: Distance to nearest well---------_--_--.---_.Distance from f-oundation..., .......Distance to nearest lot line... ------------ E' Number of pits-----------I---------Lining material__ a - 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 certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and s regulations of the San Joaquin Local Health District. {Si ned... .. • ---------------------- 9 } - -------------------------------------------------- --- (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 APPLICATION ACCEPTED BYV-- -'��-.----------------------------------------•--------•--•----- DATE----f L: .-- - --�-••--•--�_-*----- REVIEWEDBY----------------------------------------------------------------------------__---------------------------------------------- DATE..-----------------•----------•--------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------ft; DA ---------------•---:.. .-._ Aherations and/or recommendations ----1 S�-„�r�-�-- c'r L� »<� - ----- -e�X_' _ ...._.... i ----- `- ' ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- .....-------------------------------------- ---------------------------------------- -----•--------------------------------------------- -------I-•--------------- ---------------------------------------------------------------......---------------------------------- FINAL INSPECTION BY-A/.r. Date -----f - -------------------•------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 144 Sycamore Street 20S Wort 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.99 @M 11-61 ATLAS