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-- - - I�L VJL: ---------------_-----------_---------------__ 1 7 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .../. 1. -- -------------------------------------------------- (Complete in Duplicate) 7j ------- ------ This Permit Expires 1 Year From Date Issued Date Issued .._.._�t�3/_.--�-. 02r�oSO�- 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 Coun Ordinance No. 549. (/• r� ��-�� JOB ADDRESS A OCA�T3IOi N�.:: 12 1— r--- ----•- ---------------------Owner's Name.. - •--- ------- u. 'v =Phone__ .fy Address... ---------------------•----------....----- •--•------.... G � Contractor's Name---- �c ... .__ ------------------------------------------------------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1.__. Number of bedrooms _-Z'_ Number of baths J..._ Lot size __._�l�_�/.!-4�L,-.......................... Water Supply: Public system ❑ Community system ❑ Private ) Depth to Water Table ........ ft. W Character of sail to a depth of 3 feat: Sand ❑ Gravel ❑ Sandy Loam L4 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {lf yes,date--------------------1 No ❑ New Construction: Yes Ej No ❑ FHA/VA: Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r � SFptic Tank: Distance from nearest well----- -0------Distan�e from foundation---�!_-----------Material__� _ �t.[- ___________________ [� No. of compartments------m -.-.----_-f-_Size-4- _1_1_x1_---X.:�----Liquid depth....../-.P----------- -Capacity... -------- Dispos I Field: Distance from nearest well.... Distance from foundation----lk_-.......Distance to nearest lot line..S........... Number of lines----------- of each line_____X�-----------------Width of trench-------- " ..._______........._ f r Type of filter material..._. /. ---._-Depth of filter material-----./ -- Total length-------1- --------------------------- Seepage Pit: Distance to nearest well-----'----------------Distance from foundation_...................Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter_---------------------Depth------------------.---.------...- Cesspool: Distance from nearest well_________________Distance from foundation_'______.__-______.Lining material----------------------------------_._ ❑ Size: Diameter---- ----._Depth----------= '----=-=r-----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------_ Distance from nearest building_____..____.-...________-----._._______._. ❑ Distance to nearest lot line------------------------------------------------•--------,-_;-••- Remodeling and/or repairing (describe):- 't� s�-r•F ter. t ----••---------------------•---•--------------••----------•--•- -----------------•------------•-----•-------------------------------------- -------------------•-------------•----•------------------- ----------•----------------•-------------....------------- ----------.............::.-------------------••-•--------------------•-•-------------------------•-------•---------------------------•-------------•-•-----.- --------•--------------------r---------------------••-----.------------------------------------------•----' -•---------------- - ---------------------------------------------------------------- I hereby certify that I have prepared this application and that the work w,r Il,be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local H ialth District. ': }•.� (Signed)---• �/ ... fl �" -U_.-----------------------� ` 6 x + ---------------- By:. ------(Owner"and/or Contractor) CAL sY:--•---•---------------='----..1--•-------------------- ----- ----------------------• r Itle'--------------------------------------------- ------------------- a showing size of lof, oca+ion of system in rely+ion to wells, buildings etc., c be placed on reverse side). FOR DEPARTMENT USE ONLY ►4 APPLICATION ACCEPTED BY--- ------ ----------------------------------- DATE--•--.-7------- REVIEWED BY - ----------------------------- ---------- DATE. BUILDINGPERMIT ISSUED---------------------------------------------------------- -- - ------------------------•---------- DATE-------------------------. ----- Alterations and/or recommendations-------------------------------------------------.------------- •-••- -------------•----------------•------------------..._..-----------------•-----------••-------------------------------------------------- FINAL ------------•---•---------- -----•--------FINAL INSPECTION BY:....i. .... Date ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street a 1.24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REVISED 8-89 @M 6.51 ATLAS