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rix c�rrl�t ust: ---------------- -------- ------------------- -------- ------ ---------------------------------- -- ------------------------------- APPLICATION FOR SANITATION PERMI`t Permit No. ......................................... ------ (Complete in Duplicate) --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Dote Issued ---------- Application is hereby made to the San Joaquin.Local Heali'h District for a permit to construct and install the work herein described. This application is made in compliance with County(Ordinance No. 549, JOB ADDRESS AND LOCATION..-/o-, ±- J"7�--:: ��r," u�-*-3 ��'� �f� Z� ._.... Owners Name---- -�_�. %�..__ .: '.: �z�.:-- ---------- - -- - --- Phone v r -- -- -------------- Address ":-_f F----.---- -C. '_cz ,•: .._-.�� l .�`i r - r • { ` L-! f "- �w i /t /� ._.6lr.x.-c. � - ._.✓` s a:..�r mac„ !r-x,.<.,fjPhone ✓77` Lf._�- � Contractor s Name----=- ----------------------� �k---.�.--=------•----`�'------------------�y-�----�..._._=-r---=----�---------------:- _-----'----- ------= ........ Installation will serve: Residence ❑ partment House ❑ Commercial ❑ .Trailer Court ❑ Motel ❑ Other ❑ Number of living units: :__: Number of bedrooms __'Number of baths -------- Lot size _ -:- r _: _1'................—•----------- Water Supply: Public system ❑ Community system ❑ Private ©pth To Water Table -------- ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe❑ ardpan ❑ Previous Application Made: {If yes,date---.-- _--____--) No ❑ New Construction: Yes ❑ No ©. FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �--(No septic tank or cesspool permitted if public sewer is available within 200 feet.) $Ktie Tzmk- - Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- No. of compartments Size Liquid deP.t� Capacity --•--•- Dispc s, Distance from nearest well-.I.e-jO__`_Distance from foundation__._— --_-_-Distance to nearest lot line--Z-:4___r .❑�' Number of lines___: _ _. -----------------Length of each line_/6e-.__ __,t___1.�_7Width of trench-_- --------------- _ - , Type of filter materialn=1 (�k__li /-____Depth of filter material-. --------Total length___-___-- --_'-___________ Seepag it: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--__-_---________ 2- J Number of pits----------------------Lining material--_--------------------Size: Diameter_---------------------Depth----------------------------_---- Cesspool: Distance from nearest well---------_-------Distance from foundation--------------------Lining material--------------------------------__ El Size: Diameter-------------- --------•----------•--De th--------------------- ---- -------------------LiqIuid Capacity__ gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------.-------.__________-__-__. ❑ Distance to nearest lot line--------------- ---------------------------------••-----------___---••----••--------------------------...-._..---••....................... Remodeling and/or repairing j----------------'------------------------•----=rj f-----------•-----------•-------------.---------•----------------------- 71 -------------- -------•-- ----- - ---------------•---------------------------------------- ------------------------ ----------- ----------------------- y --------•- -----------------------------------------------Z---------------------------------------------------•-------------_-••------------------------ I hereby certify that I have prepared this application and that thefwork will be done in accordance with San Joaquin County ordinances, State laws, and rules-and regulations of the-San Joaquin Local Heal District. l j • St ned �_' .__ _" - 5 ) a `._. ._ ..� a r�' `- ) oe"n / r Contract ) By:--..._.. ----------------- ---------- U., ------------------------------------ ....... )Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). v `U FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B��-- --- - ---------------------------------------------- DATE_.1/_;- '`---/,_� ----------------------- REVIEWEDBY---- ----------------------------I--------------- ---------------------------- DATE-------•--------------•------------------------------------- BUILDING PERMIT ISSUED----------------------------------- ----------------------------------------------- DATE---- --------------------------------------------------- Alterations and/or recommendations:--------•------- ---- - ---------------------------------------------------------------------------------------------------------------- ------------------ -------------------------------------------------------------------------------------------------------------------- -------------------- -- ----------- ••------ ------------_--------•----------- ------------------ --------------------------------------------------------------- -----------•----------------------------------- --------------------------------------- ---------------•- •------------------------------------------------------------------------------------------•-----------------------•---------------------------- ------ --------------------------- ................. ----------- ----- -L---- -----•-------------------------------- -----•-----------•-------•------•- - --------- ------------------------------- - r C FINAL INSPECTION BY:...... +L _ Date_--- r J y --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreit 124 Sycamore Street 20$West 911h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS