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-- --------- - ------,___- �. ---------- -,.- APPLICATION FOR SANITATION PERMIT Permit No. f�fJ-------- (Complete in Quplicate) Date Issuqod . ------ 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 herein described. This application is made in compliance with County Ordinance No. 549. ; i ,. IF-------- OwBnerA'sDName S..AND LOCA��Q.... ..j'� - ----•--•-�r--------��--- ----- -------------------------- Phone...4-0..... -�►��..�. 1 - .... --- --•--•------------••--------------•-•-•--------------- Address......... Contractor's Name........ ........... .. --- # ' �---- , ------------------------------------------ -----------------------------••--------•------------- Phone............................... Installation will serve: Residence❑ Apartment House ❑ Commercial ❑ ..Trailer Court;[] Motel ❑ Other Vls�t• Number of living units:....-!---- Number of bedrooms __ __-- Number of baths Lot siie ---- ......... -••----•--•---- Water Supply: Public system Community system ❑ Private ❑ Depth'to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand,E] Gravel ❑,-•Sa'ridy Loam El Clay Loam [j. Clay ❑ Adobe❑ Hardpan ❑ Previous Application Mede:: llf yes,date----------- f No 9 ew Construction: Yes ff No ❑ FHA/VA: Yes ❑ No �^ TYPE OF INSTALLATION AND SPECIFICATIONS: 5 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ r _QDistance from foundation___�._Q-_'-#'__.Mater�aiRed-W-1-91 06 -,•__••-• . compartments_ T Size g.)S. 7 -._.__.Liquid depth Capacity Disposal Field: Dotanc, � � p � p ,from nearest well--5-Q' ---Distance from foundation.-1.O _--+__-Distance to nearest lot line..__._... Number of fines-------------C--------------------Length of each line,-------Tof trench.----_-- --•----•-•---••-- Type of filter material.-jZoic-14-_Depth of filter material--------- .--Total length-------------0�G .--.._________.._.-__ Seepage Pit: Distance to nearest well------------ from foundation...-.---.__-----__-.Distance to nearest lot line,; _..__.. ❑ Number of pits-------- --------•----Lining material-------------•---------size: Diameter------. •----------Depth---------•------------•--------- Cesspool: Distance from nearest well----------------- from foundation--.._- :------------Lining material-------------------------------- ❑ Size: Diameter Depth ------- r =---------Liquid Capacity-----------------•-•--------gals. Privy: Distance from nearest well------------------------------------ __t_%_Distance from nearest building---:..-_______--___ ❑ Distance to nearest lot-line----------------------------------------------------------------•-- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------- -----.....--•----------------•-• ' ___________________________________________________________________________________________________________________________________________•_-_-_____.---...._________--________.._.________.._ --------------------------------------------------I_--__--_____..__--___-___.______---__-____.__-____.__.. I hereby certify that I have prepared this application and-that.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. (Signed)---------------------•-------------------------••----------------------------------------------------------------- - ---------------(Owner and/or Contractor) - ------------------------------ I •----------------------------------------------)Title)-,---------------------------------------- (Plot plan,s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- . ---'- -- ------ - - ----------- -----------------•----------------------------- DATE--- REVIEWEDBY---------------------------------------- -- --•-- --------------------------- DATE------- -- -------------------• -- ---------- BUILDING PERMIT ISSUED,----------------------------------------------------------------------------------------------•-•-- DATE.... .. Alterations and/or recommen a tons•-_ L + _...----•----------------- ............. ------------•----•---------•-------•---- - A r__.. _ -- '-----------------------• ----------••----- --••-- •--------•-•--••-------------------•-...- --- ----------- -•------:,-_••-------------•---------•--------•-•-••-•-------------------•-------------------------- FINAL INSPECTION BY:.-/_.... � ---- ----- Date `' ... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 5-59 2M 5-61 ATLAS r