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rvK Ur•rll.t UJt: ......................................................... �a .................................................... APPLICATION FOR SANITATION PERMIT Permit No. .. ..:.�...�5.�.. .............•--•---...................••-••••......-- (Complete in Duplicate) ✓ / Dote Issued . - This Permit Expires i Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to con ruct end install the work herein described. This application is made in compliance with County Ordinance No. 549. 055—e�3Z) J08 ADDRESS AND LO ATION. -...- ----s/" ��.�`✓�f _.,"'TION- ........................ l Owner's Name -- --- . ..... .. ... ....- �... . --. . Address 'I......................................................------------------------------------------------------ Contractor's Name... [.��, ' ti" r.......................�tr, 2,� ..........installation will serve: Residence ❑`~Apartment House ❑- Commercial Trailerrt tel ❑ Other ❑ Number of living units: ........ Number of bedrooms ... ... Number of bets _�` Lot size ............................................. (Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _ ... ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ layi-64n ❑ 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 pu lic sever is available ' hid 200 feet.) -�- T S is Tankc' —D;s#ance from nearest`wel Dista fr mA�,( n------:(..--------Mateerria1.--v't'l/L Cifai --- !`tl No. of compartments-..-_ - Sizes � -` i uid d- th_..___.. _..........Ca eci �LW..._. 9 P. P ty.. ....... . Disposal Field: Distance from nearest wel . .110 Distance fro n:.-=T." Disiance to nearest lot line....Cll..... Number of lines..._!-.._ �•. ..`'Length of each fine.....I................. of trench-:...�{-�'.�'................. Type of filter materia rj Ticsr`{ Depth of filter material.....1. ''.___..Total length...../t7 ............................ Seepage Pit: Distance to nearest we I................�4.Distance from foundation..-._:...--._'..Distance to nearest lot line................. ❑ Number of pits----------------------Lining material.......................Size: Diameter..............-........ Depth................................. Cesspool: Distance from nearest well,................Distance from foundation--..................Lining material..................................... ❑ Size: Diameter-------- -•.............Depth.._-.._._...........--- ---....-......---.-•--..._Liquid Capacity.........................._..gals. Privy: Distance from nearest well.................................................Distance from nearest building.......................................... ❑ Distance to nearest lot line...............................................................----•--•--------•---- -------................................................ Remodelingand/or repairing (describe):----•--•-----••-•---•...............•--•••-•-..........................••------•..._................--••••-•••-••••---••...._.....•-•-........._........ .........................................��.............•--................-•-•-------•-••---..._....-•---•-•••-•-----••-•-•.......................--••••-•--•••.............•.......................................... ...........................................• ..........................----..............- ---•--.........._.......--- . ...........-•------..........---••-••--•••--•-..._......----....................-•..._.............. I hereby certify that I have prepar this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and g la ons of the San Joaquin Local Health District. (Signed) 1 9 )---- --------• ...........:........ (Owner and/or Contractor) BY:.......................................( -. . Title -. (Plot plan, showing sine of,Iot, location o system in r lotion to wells, buildings, etc., can be placed on reverse side).;4 el _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. ......................... ..•---- DATE---- �r"-.G- -r..._.._..._............._. REVIEWEDBY--- ------------ -------•--•-•--.....-----..........................._........._..••-•--...•-••-••----•............-•-....... DATE............................... BUILDINGPERMIT ISSUED.............................................................._...................................... DA-TE............................................................. Atterationsand/or recommendations:.........................................................•------•--.....---....................•---......................._........_....•---................... .......................................................................................................................................................................••-••••--......................_..........._........... ................................................................__........-............................................................................................................................................... ..................•--............---..................................•.......---..........••..........._............--•••••.................................._..--••-•...•••........................................-••...... .................:............................................................................................................................................................................................................ FINAL INSPECTION BY:... . . . . - - . - - --------- . Date . . .0 2� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Stet 205 West 9th Street Stockton,California Lodi,California Manteca,California Trocy,California CO 9 REVISED 6-99 214 8-61 ATLAS