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FOROFFICE USE:/ --------- -- - q .._-_..✓___.___.._. l f -7 --------- APPLICATION FOR SANITATION PERMIT Permit No. .. `7.`�__------- I ---------------------•------.._..----- --- ------------ (Complete in Duplicate) -'�`-�` � This Permit Ex fires 1 Year From Date Issued Date Issued ......................: Application is hereby made-+o 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 Ordinpige 7, 54,9.r J JOB ADDRESS AND LOC ON Q►_.s... . .. U Owner's Name -------------- ---- . ---------------- Phone------------------------------------ Address............ . S -----_Address-----•-----•............... 1 Contractor's Name..--- --------- -------- ., Phone--------- ..---....... ................... Installation will serve: YResidence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .... Number of bedrooms ... Number of baths __ Lot size ......A�n........lx---?�:_y_____________ Water Supply: Publiclsystem ❑ Community system ❑ Private Cff Depth to Water Table -------- ft. Character of soil to a depth,-of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay (] Adobe a Hardpan ❑ .4 1 Y #- Previous Application Made: '(if yes,�date---------------------) No ®- New Construction: Yes ®° No ❑ _ FHA/VA: Yes [& No ❑ TYPE OF INSTALLATION-AND SPECIFICATIONS: A (No septic Tank orcesspool permitted if public,sewer is available within 200 feet.) Septic Tank: Distance from nearest well..._____.__ .Distance fr9m foundation----- ....... Material at er1 ¢.__ 6 ai_______ ' ._.( - Q -- ------------ No. of compertrnents---•-------P-----------Size---- Q.- --- 6- iquid depth--------y�------------Capacity_...f Disposal Field: Distance from nearest well.._.✓`-4� Qistance from foundg,ion____!r "'_.Distance to nearest lot line.....:`:.f._. ZI Number of lines--------------____ _ Length of each lin �l��R,��s�CJ1+Vldth of trench.--------------- Vel Type of filter material.�, l�a _l2a epth of filter material..___/_ ___-------Total'lengt ...................... Seepage Pit: Di stance►to,nearrest well____________ _______Distance from foundation....................Distance to nearest lot line._..._........... r+< ElNupber.of,plte,!.'__-�........_.___Lining material-----------------------Size: Diameter----------.------------Depth----------...................... Cesspool: Distance, from t -_n_earest well____ Distance from-foundation-...:.:..,..........Liningm _ ..-..—..�=-":} ___.❑ _L_'_ ------ El Sze: Diameter_-`___________________________________Depth,...- .--- : --------_Liquid Capacity--------- Privy- }--- Privy: Distancek from nearest well___.'____-._____- ------------------------------------------- ---------Liquid frome..._g..a.3ls_. nearest building .: ❑ .; r , tante to nearest line----•`-----------------•------------------------••-----------------••-- ------------------------------------_---------------------- Remodeling and/or ra'pairing (describe): -----------------------------------------------------------.. t •Io� • 4 . _ A -----------------------------------•-•-•------------•....... ---------------------------------.--------------•---------------------•-----•-------------------•------ ---------------.----•---•-------- ' _ _ __ -�---------------------------- - —a.---- •. w I herebycertify thaf,l have prepared this a lication �n ,loo l Loc ill e - e in ----cot c with Sa .ui n - y y p p pp and That the wor will be done in accordance with San Joaquin County " ordinances, State laws,and rules an a -ulaY ns of fh'`Sa q li ealth District. (Signed).----- ...........------------------------------- ------------ --------------- .. (Owner and/or Contractor) ______ Plot Ian, showing size�of W location of system in:.relafion t Y By:--•-----------------4-•-................•- =----=--- - - - ----- - --... '----------------------(Title)--------• -••----------------------...................-........ ( P 9 � �� y o wells, buildings, etc., can-be placed on reverse side). { `"' °�" FOR DEPARTM T USE ONLY r r i APPLICATION ACCEPTED BY. - - --- - - ------------- DATE �2/ --- ---------------- REVIEWED BY` "- -` --------------------------------••--••-•--------- ---- DATE BUILDING PERMIT ISSUED.---- -- -----.f"'• ----- — ••----•-------------- DATE-----•----•--------...-•-•------•-.._.... Alteirafions end/or t.;. , •• recom menda;ti 77 oons: l ' - ------------------------ --•--...-..---------------------------------........-. .-------•---------------•----•-------------------.. 11 _.. . ------- - • ----------- ._.... ----•-- ••---------- ------- ---- ----------- ---•-------------------------------------•- •----------------- ...................•-•...i ----------------------------------- ------- --------------- ------- -------------------------- --------------------------------------------------------------------------- FINAL INSPECTION BY:----f -• -•-- Date------- - � -.2�.;---------------------------- •--••--- i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wed Oak Street 124 Sycamore Strut 305 West 9th Street Stocklonr California Lodl,California Manteca,California Tracy,California ES 9 REVISED 8.59 ZM 5-61 ATLAS