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FOR OFFICE USE: s �- ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ----- [Complete in Duplicate)- ---------------------------- -------• --------- Date issued ------�L---....� ..------ This Permit Expires 1 Year From Date Issued , Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he in described. This application is made in compliance with County Ordinance No. S49. 1 ��1Ii i LOB ADDRESS AND LOCATION .. - ( p 4� ---F ' _ ..1...1� - ----Sa`�r �-,{- --------------------------------- Phone•-_.�..`j_�. Owner's Name...._�. �---------------------------------------------------- --- - Address - ��-•il -•,•---.• - p i s-------------- ---------------------•--------•--•-••------------- Contractor's Name---------- -- ------------------------------------------•----------------••-------•-----• Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ d :Number of living units: J---- Number of bedrooms 'I,- Number of baths ___�-_. Lot size ---- .`}_©____ ._.......a .....------------ Water Supply: Public system ❑ Community system ❑ Private Dk Depth to Water Table ....._ ft. F Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam JW Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,dase___-'1%e0--------) No ❑ New Construction: Yes 5� No ❑ FHANA: 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____: 'Distance from foundation___ _ ---------Material...` " � ------------------------ _ __�'_Y '��L` _-----. No. of compartments------- ---Liquid depth_--------_--._------_____Capactty-- 0._.. Disposal Field: Distance from nearest well-1-19 --_Distance from foundati n____. .1�__>-____-Distance to nearest lot line. �..� Number of lines_________ _____________Length of each line_.___ _______-_ idth of trench-------Dg* ��...... Type of filter mate rial__: .0------Depth of filter material........_--------------Total length........Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line____________-._.. E] Number of pits----••----------------Lining material.----------------------Size. Diameter-----------------------Depth---------------•-_--_____..______ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_______-___--__-_-___________________ ❑ Size: Diameter_---- '-------------------- ----------Depth-----------------•---------------------------------Liquid Capacity----------------------------gals, w Privy: Distance from nearest well l- ___________________________________________Distance from nearest building------------------------------------------ 0 Distance to nearest lot line----------------------------------------------------------- -----------------------------------------------------------•----------------- Remodeling and/or repairing (describe: _Q.> � ( ;S �:...;.. ----------•------------------------- ••----------------�--------__---------------•-•----------•-----___-•------------•--••-•-----------------------------•------•-----------•-••----•-------------------------- -------------------- --------------------------------•- ---------------------------------------••--------- ------------------------------------•-•----- ------------------------------------------------------- . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, StateI , and rules an4 regulations of the.San Joaquin Local Health District. (Signed) �� -------- --- ------------------------------------------•• ------------------- ------------------- ----(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 ------------------ DATE-----. '� 'Z— APPLICATION ACCEPTED BY---- -- --- -------------- - ---- -- --------- --- - ----- - ----- REVIEWEDBY-------------------_--•--•----------------"------------------•- ------ f-----------------------------•-•---------------- DATE---•---- -------------------•-•...............i------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------------------------- -•------------- -� Atterations and/or recommendations:-----------------------------------------------I----------------------------•---------------------------------------------------------------------•-------• -- ---•-------------•--------------------..--.----------------------------------------------------•-••--------------------------_-_1--------------------------------------------------------------------1*11 ----------------------- ------------------------------- ----------------------------------------------------- -------------------------------------------------•-- r ----------------------------------------------------------------------- - FINAL INSPECTION BY- Date-1-:6'.- -------------- -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreei 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,Colifornla ES 9 REVISED S-B9 8M a-el ATLAB