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rUKUNI-ILt USt:--------------------------------------------------- - 4 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------- ------------------------- (Complete in Duplicatel --------------- ------------ - ------•-----• --- 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. 4 c� ! JOB ADDRESS AN OCATIONJ..cC_ --"�__ ( ---••--•----------•---•-----------------•-----------•--------- Owner's Name --------------------------•-••----------------- Phone-------------................... Address.._ ,� _ ---------------•-------------------•-- Contractor's Name............................. . - Phone ........a>� I Installation will serve: Residence [2-'—Apartment.House Commercial ❑ E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ Number of bedrooms _a. Number of baths --/-. Lot size -_-" - .�._x"/__ __D - .. Water Supply: Public system ❑ Community system ❑ , Private UT"Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Loam Clay L ❑ Clay ❑ Adobe � r tlardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No [B--IHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pia�mitted if public sewer is available within 200 feet:) tic Distance from nearest well___------_.-"_--Distance from foundation....................Material-----..----"---._----- "_____. No. of compartments--------------------------Size-_---------•----------------,_.-Liquid depth------------- Ga aci ' Capacity ................ Disposal Fie d: Distance from nearest well_SQ-------Distance from foundation--�_42....-__•Distance to nearest lot line--------- "..... Number of lines_.! """ Length of each line----- 2"�_._..�.-""._.Width of trench.-_"_Q"�" .." Type of filter material." ------Depth of filter material..._-f -----------Total length 7 .5 ----•----•- Seepage Pit: Distance to nearest well---------------"------Distance from foundation--------- Distance to nearest lot line._._•" ❑ Number of pits Lining material ------Size: Diameter------- -----Dept h-------------------------- esspool: Distance from nearest well-___--_------_Distance from foundation--------------------Lining material_---.-............................... ❑ Size: Diameter----• ••------ --,...Depth----•------------------------------------------ - is " _Liquid Capacity-.-----•--.--•--------••_--.gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building Cl Distance to nee rest lot line."-"_-"_-.""--- Remodeling and/or repairing (describe)------ ------------ I ------------•---"--------•-----•"-------------•---••------•-------------•------------------------------•--••-------•------•------"-"------• -------•-----------"•--- ---------•---••----------••---------------------- 1 ...---•------.-----•--------•--------------•------------- # ---------------- --- ---------------------•---------------------------------------------------------------•-------------------------------------------------------- -------•----- I hereby certify that I have prepared this application and that the-work will-be done in accordance with San Joaquin County ordinances, St laws. and rules and' guI tions of the San Joaquin Local Health District. c. (Signed)-••--.--""------------------""-- --- --- -. - - .- ner and/or Contractor) � - -------------------------- By - (Ti+le) (Plot plan, showing size of lot, location'of system In relation to wells, buildi ., can be placed on reverse side). FOR DEPARTMENT USE NLY APPLICATION ACCEPTED BY.--- = {----.6t,�9- 5--------•----------- - - --•------------- DATE------�1_— 17 --------- EVIEWED BY-"------------------------------------"�-.....-------•---=------ DATE----------------•---------- ............-----•-- ------------------ UILDING PERMIT ISSUED ------ -------------- -- DATE. Alterations and/or recommendations:-:1-""-..-""-."."-___:---------------------------------------------------------" --------------••......--•------------------------------------------------------- i ---------- ---•--•-"---------------•-•------------ ---------- ............... ..................... FINAL INSPECTION BY: -----------------------� SAN JOAQUIN LOCAL HEALTH DISTRICT 4' 130 South American Street 300 West Oak Sireel 124 Sycamore Street y.�.•^` 205 Wert 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED 8•89 8M 8-61 ATLAS -