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FOR OFFICE USE: --'---'------ ............. - ...................... / g „....................................................... APPLICATION FOR SANITATION PERMIT Permit No. - -------------- -- (Complete in Duplicate) 03/ .....-. This Permit Expires 1 Year From Date Issued Date Issued .-...--->. 6. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describbd. This application is made in compliance with County Ordinance No. 549. "1);- 00_?-Vq0-I 2_ JOB ADDRESS AND'LOCATION....... !../014LrTiu_...-----------------------------------------.-------- OwnersName.-..--- ---------------. ........... ......................................... Phon4..-X_-.--------.-..... Address......................... � -}-- _ ii B Q................... r`c`-.................. ..--.-...- ---- -------------------------... - Contractor's Name....... R✓ ..�f ...............-----------------................. Phone...-.............................. Installation will Sarre: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Z-_-- Number of bedrooms -�L. Nurhber of baths.!.---. Lot sizeR�...Sys,sOu.....................................• Water Supply: Public system ❑ Community system ❑ Private- Depth To Water Table - fl ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 50 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,data....................I No ❑ New Construction: Yes ❑ No ❑ . FHA/VAi Yes ❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - --- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ..Distance from foundation--_-------........Material.................................................. ❑ No. of compartments..........-...............Size...........................—Liquid depth................---------Capacity....................- Di field: Distance from nearest well. I..-Distance from foundStion....lt�.......Distance to nearest lot linaCj-___----- Number of lines___._!-_____..__._.--_-_- Length of eachJlne,..,/....---.N....-Width of trench-...2-#.r....-.............. Type of filter materi - wkl Depth of filter material-__/f_-..-.-._...Total length.-..�.....-..................... Seepage Pit: Distance to nearest well----------------__----Distance fromtfoundation...................Distance to nearest lot line....-----.--.--.. ❑ Number of pits......................Lining material......._..._..........Size: Diameter.......................-Depth................................. Cesspool: Distance from nearest well_..............Distance from foundation............._......Lining material......-......-.......,............... Cl Size: Diameter..-----------........................Depth...........----------- ............................Liquid Capacity--.......-...............-gals. I Privy: Distance from nearest well--------------------- .-.....-..........Distance from nearest building.......................................... c ❑ Distance to nearest lot line...........................------7..C.-................................-......................--------.......-_--_-_--_---_--...- Remodeling and/or repairing Idescri6e)-------------- --/+ --- - .........._......................--...................................................................... -- ........---------------------------------------------------_ -----_---_ ..........I..................:............................................................----------..... ----- -- -...-----........---•-------------------•-----.--....------------.-....-..._..- _- - ---- ------------------------------------••--------.---..---...--.................- hereby certify that I have prepared this application and that the work will be done in accordance wifh San Joaquin County ordinances, State laws, and rules ante�d•• regulations of the//San Joaquin Local Health District. -.-..S cin ._.: -' > . 4n......-.-_.........................................-------•-------- (Owner and/or Contractor) By:-...... Q. �..._[�! (.`�ltse. `'-`---------------------..................--------(Title).........�.a.-�...I ...._......__. ..__ (Plot plan, showing sae of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ............................... DATE-:3-:.1--t/:n6;?..........._--_------------------ REVIEWEDBY................................................................-........... ---.............................. ---- DATE.................._..................................... BUILDINGPERMIT ISSUED..................._.......................................----..............................--- DATE................................-•-.._---------------- Alterationsand/or recommendations:----------------- ------------------'__..................................--------•----.---_--------_........................-_---_------ ................--- -- ...........................---................... ..................................---•---------•----..--.....------- -........_--------------...-----...-•----•-•------------------••-- .......................................------------.....-.......--------...----------•----....................................-----------------.............. -.._....................--•-............-...........-------------------------------------------------•---------------------....----------------........-----....-........-----'- -----------...... ---------•..........:.................. ----9-...-•----.:...................... ..........................I........ FINAL INSPECTION BY:.��l'Y% r�(-- - ._... Date.-. ............................- ..._....... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 Wut Oak Street 744 Sycamore Shoot 205 Wed 9th StnM Stockton, California Lodi,California Montece,California Tracy,California .. ES 9 REV15E0 a-59 2M 5.62 ATLAS