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FOROFFICE USE: ' ---------------------------------------_----------- - -� -------------___----------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ._�1J� ` -- -------------`------------------------------------------- (Complete in Duplicate} 7/ Data Issued --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h District fora permit to construct and install the work herein described. This application is made in compliants with County Ordinance No. 549.E / /�'��• � /� dos-ADD. . �. " ESS AN-D' C ATI`O - - - ---l Owner's Name. --------- '" j� 1�_...a - Phone Address -----•-----• -�-.S---Q 4 ----- �"`' n 1�- ---`E / ------ •----- -------------------- -- Contractors Name---------- ------------------------------------------ Phone.................................:. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court lf_ M/otel ❑ Other ❑ Number.of living units_'Number of bedrooms__ Number of.baths 0?-_ Lot size ------fir-•.... �1�'��_------- ___ Water Supply: Public system C] Community Community system{❑ Private Dep+h to Water Table _ f#. Character of soil to a depth of 3 feet: Sand E]—Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay E] Adobe ardoan C1 1.Previous Application Made: (If yes,date____________ ______) No ❑ New Construction: Yes Erllo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ir (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SFptic 7 No of compartments Distance from t""well_ """Di can from foundation..luid detth-_Mahal-.4---�CcJ_.. -- -: -- - i Do Disposal Field: Distance from nearest weILQ-__'_Distance from . foundation__10..._.....Distance to nearest lot � ..... Number of linesC -------Width of trench-------- '- -•-•------ f ® _Length of each line___--/ Depth of filter material______ S__ ___.Total length__________________Z, LType of filter material / ........... I Seepage f: Distance to nearest well.,�.e___-___Distant ndation_._ __.____.Distance to nearest lot line-----........ Number of pits___.________-------Lining material_ Ize: Diameter__..___..-3 __ S Depth Cesspool: Distance from nearest well_ _________Distance from foundation-__--.--------------Lining material----------------------------------- r ❑ Size: Diameter---------------------------------------Depth------------- ------------Liquid Capacity gat:• Privy: Distance from nearest well_----___________________________________I----Distance from nearest building---------------------------------------- -------- Distance to nearest lot line. _.___ - -- - —"r'•� ----- ; ------- ... :� .f Remodeling and/or repairing (descrihel:-. 4P ---•- -•----- � . �w =s--- - ---------------------------------------------1 r �� w __----•---"-----•---------•-•---•------------•--•••----- --------------•-• ----••-----------------• ----•-•-----• ----------••- ------------------------•-•-•--•--------•---------- ----------_----------.----_ •------•-----------------••-•---•---------------- ,_ l I hereby certify that I have prepared this application and that Awe_k will�be done in accordance with San Joaquin County ordinances, Sta a s, and rules and egul ions•of the'"5 Joaqui o al He h Dis+rict.-1--1--- w�-- �-�r---'* - - �_ n t 6wner and/or Contractor) (Signed)----- ----•- .._.. -' -------- -------------------------------------------- By: {-•''- By:-----------------_- ------------------------- (Title)------ f----------------•--..._... (Plot plan. showing size of lot, location of s;6m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----. --- --------------------------•----•------------------------ DATE--- y - -------------- REVIEWEDBY----- ------------------- -•---------------------••- DATE---..._.....-----"----------------•-•---•---••--_._..._..-- BUILDINGPERMIT ISSUED-•----------------------------------------------•-••--•-•-------------------------------------------.. DATE_---------------------------- Alterations and/or recommendations:-------------------------------------------=- -............. ----------------------____----------------•--- -------------------------------------------------------------------------------------•------------------------------------------------------------------------.-----•---------__-------------•--• -------------------------- r FINAL INSPECTIONBY: --------•------ Date...... '-✓..-�t ' SAN JOAQUIN LOCAL'H_ EA_ 'LTH DISTRICT 130 South American Street 300 West oak Strut T24 Sycamore street 205 west 9th Street Stockton,California Lodi,California Monteca,California Tracy,California ER 9 REVISED 9-99 2M 5-61 ATLAS