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rUKUrrlc:lv�� APPLICATION FOR SANITATION PERMIT Permit No. . S. f'.1... r - - (Complete in Duplicate) ------ - r�------ - This Permit Expires 1 Year From Date Issued 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. JOBADDRESS AND LOCATION._34-- -- _ A----------------------------------------------------------------•-----...................-_•-----...._..---- Owner's Name---- /_!�»7 ------ �W_A_AAti*..---•---------------------- --------------------------- Phone............. --••- Address. 13 c�''`-�._.. _ -------------------------------------------------------------------------------------- Contractor's Name �_..�------�--?--------•----- ------- Phone................................... Installation will serve: Residence ❑' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___,--_- Number of bedrooms x%L_. Number of baths __/---_ Lot size ------------------------------ Water Supply: Public system ©Community system ❑ Private ❑ Depth To Water Table _ _A__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Pq'� New Construction: Yes to Ey- FHA/VA: Yes ❑ No [- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic _ Distance from nearest well_-__ stanc�from foundation----�-�----- .Materi P ----- •size ?'cs-Liquid depth------- -------------Capacity---� '� 7_ of com artments............. ¢ Disposal Field: Distance from nearest well..."-----_-Distance from foundation.....�U---........Distance to nearest lot line...-f........ Number of lines.....__.I------------------------Length of each -----.-.Width of trench...._ !---`-' _o_�A .-..-._----_----- Type of filter material._? -------Depth of filter material_!Y---4-_----___--_Total length ............... Seepage Pit: Distance to nearest well_± f--------Distance from foundation--./ ............Distance to nearest lot line---_�------- (N E9/ Number of pits-.,l-------------.-_Lining material C_ ...-..Size: Diameter_--.3-j------------Depth-------a2..;S ----------- Cesspool: Distance from nearest well-----------------Distance from foundation._.-----------------Lining material------------------------------------- El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building----_...---____-___---.-.___--.----._----. ❑ Distance to nearest lot line------------•-----------------------------------------------•--------- ------•--•------••-------------------------------- -------------- Remodelingand/or repairing (describe)----------------------------------------------------------------------------------=-------------------------------------------------------_--••-•---•--• ; •------•---------------------------------------•-•---•------••-------••-----------------------------------------------------------------------------------------------•---------------------•-------•----•------------------- 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 r ula ons 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). len FOR DEPARTMENT USE ONLY 77. 01 ------------•------------------------ DATE_.--- -----.... r --------- APPLICATION ACCEPTED BY-.-.. ._r_..__ �B-ti..��r ___-______ .- REVIEWEDBY-------------------------------------------- ----------------------------------------------------------------------------- DATE------.................... BUILDING PERMIT ISSUED.--• ..... --------- ------------------------------------- DATE------...--• Alterations and/or recommend' (ions;___-._. ..._.-_ -_______•-------- ----------- -----•----•-----------I----•-------------------------------------------------------------------•---------- ----------------------------------------------------•----------•------•----------------•-------------•-••------- FINAL INSPECTION BY:------ --•-- --- ---- • -------------- ------ Date--- - 3--------•--- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLAS