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FOR OFFICE USE: ------ ---------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- .r; (Complete in Duplicate) ---------. This Permit Ex ires ] Year From Date Issued �� a Issued ._ ,� 1 -3 �� Application is hereby made to the Sen Joaquin Local Health District for a permit to cons rust install the work he el d bed. This application is made in compliance with County Ordinance,N 54/� -ffj�477/,�7A.0 _ JOB ADDRESS AND LOCATION--- ................ ............ Owner's Name--------------------- �gApartment �� ------------- Phone----------------•-Address------------- Q �.--•-------------------------------•---•-----------------------.----------------------------••--------------•---- Contractor's Name--- �--•- Q ------ ------ --------------- --------- Phone._•...........•-•---•-------•--•... Installation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .--)___ Number of bedrooms -__3 umber of baths -I-_-_ Lot size _ .,X/..?---------------„ Water Supply: Public system El Community system Private ❑ Depth To Water Table.5 t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: [If yes date___.__-____._.-__._) No New Construction: Yes to 0 FHA/VA: Yes � [3TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well,----.-----Distanc,f ro ounI�ation_ d./.------.Material_G_a"�?6C�' No. of com artment r Siz 7�Liquid depth-_--_�.-_...._--- Capacity__ p �--- --------jcr X ,lav Disposal Field: Distance from neareFit well--!M--------Distance from foundat}'�on�..�,7 Distance to nearest lot Iine..J�______________ Number of lines----- t............. ...Length of each line---•% --'___••...---_--.Width of trench----r:�-f- ---••---------•• Type of filter material__11_/�e -Depth of filter material-_,1_�J'----..Total length__��!__._...____,,_,,,_//._i_. See pag It: Distance to nearest well—/'R' _____________Distance from foundation__-____-_._..-_.Distance to nearest lot line-- Number of pits-----?,._,1�.__Lining material-V)e--_...Size: Diameter_..&.E/-----Depth_. Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material--.--------------------- .__--__----- ❑ Size: Diameter------------ -----------•------------Depth----------------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building------------------------.____ ._ - ---------- 11 Distance to nearest lot line - Remodeling and/or repairing (describe):--------- ---f -�t!!'__. �o ------ ------------•----------•-••------------•-----------•-----------------------------------------•----------------•--�----------------------------•-----------------------------------._---- � --------------------------------------------•-----••------------------------------ ------...--•------------------•-•-------------------•---------------•-----------------•----•-•-----•----------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, State laws, andes d regul 'ons of a San Joaquin Local Health District. (Signed) ------------- ---- -- - -•••------- - --- ------ ----'to ---- •------ ------- -- ------••----- •-------------------(6wrrei an41-or Contractor] By:--------_--------------•-------------•-----------•-------------------•------- --------- Title-- (Piot plan, showing size of lot, location of system in rel r n wells, buildings, a+c., can be placed on reverse side]. ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED DATE i ..---- REVIEWED BY ------------------ -------- - --- ---------------- -------- DATE BUILDING PERMIT ISSUED------------------- ---------- --------------- DATE_�r Altera+ions and/or recommendations:_ �r %rt --------------------------•-•----------- ---••--------------••------------- ------- ------------ --------. ------------- ------ FINAL INSPECTION B .�� Date-1-5x -1<7- AN JOA IN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 124 Sycamore Street 205 West 9th Streit Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS