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........... -- --------------------------------------------------- APPLICATION FOR,SANITATION-PERMIT Permit No. ...l.✓.�� ------------------------------ ------------------------- (Complete in Duplicate) ------------------ ----------- ------------------ --• I This Permit Ex ires I Year From Date Issued Date Issued .._�!__L /�-� 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 yrainnceNo. 49. JOB ADDRESS AND OCATI ------------•- Owner's Name........ ................ . --------------------------------•---- Phone.................................. i Address................... •--•-- i Contractor's Name........ .... ---. Phone.......................... .. Installation will serve: Residence Apartment House ❑ Commercial [3 Trailer Court E] Motel ❑ Other ❑ Number of living units: j___. Number of bedrooms_. Number of baths .,l._-_ Lot size L � '`� •-•-----•---•--••-------------•- Water Supply: Public system (] Community system &rivate ❑ Depth to Water Table 440—K.CharacteF 0,s6il to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Eq—'iRardpan ❑ Previous Application Made: (if yes,date--------------------) No ,-"New Construction: Yes [j5'No ❑ FHA/VA: Yes K�`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___ P-Ll DlStan rom foundation.... ! ` . --------Mat�ii I__ ,�'_ _ No. of compartments---y�__--....___-_____Size__,f .�! yy ..Liquid depth__ - Capacity_ Disposal Field: Distance from nearest well-.149,�Distance from foundation___ a_. .....D stance to nearest lot line,.J"., Number of lines------A......------------ ---Length of each line_/�` �- -Width of trench. ___...._____...______.-•• Type of filter material. fAF4?epth of filter material ------_Total length Seepage Pit: Distance to nearest well--_ .�,�e__Distance f m foundation....A�..___. • t�e to nearest lot line_J ..... --- Number of pits.... : Lining ma#erial. .Size: Diameter ..___De th_ - -----•-• P ,mat-..----•--•-------••-- Cess _-------------- Cesspool: Distance from nearest well____.______--_-..Distance from foundation-__._.__-__-_.___.,Lining material_____________________________________ P • Size: Diameter - Depth-; ------Liquid Capacity gals. Privy: Distance from nearest welL_-_-_._____.---- ------------------------------Distance from nearest building------------------------------------------ Q Distance to nearest lot line------------------------------------ --- ----------- Remodeling and/or repairing (describe):.... -• ---------------••------- •-----------------------------------------------------------------•---•------------- -•-------•------------••------ -----------------••--••--•----------------- ---------------•---------------•-----------------•------....-------••---------•-----------•--•-------•---...---•--------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rulps and regulation of the San Joaquin Local Health District. (Signed). -------- --• -- or Contractor) By:------------------- -----------------------------. ...------- or� (Plot plan, showing size of lot, location of system i ation to wells, buildings, etc., can be placed on reverse side). FO,R DEPARTME T USE ONLY APPLICATION ACCEPTED BY_ _.__ --- __ - ______.--_ DATE___--R VIEWED BY / ------------ ------ ... ------ ----------------- --- -------------------- DATE----- •---- .._ - c ---c' 3 . •. BUILDING PERMIT ISSUED--------- DATE------------- ------------_e- ------ Alterations and/or recommendations:.. -_--_ _,may . —5--------•-----•---------------•------..--------- ------------------------------------ --------•------------•--•----- INAL INSPECTIO - ---- ------ -- ---- - Dat ------------------ SAN JOAQU LOC EALTH DISTRICT 130 South American Street 300 West Oak S eet 124 Sycamore St r t 205 Wer 9th Srr••r Stockton,California Lodi,Callfornla Manteca,Cal ornia Tracy,California E$ 9 REV4SED B-99 YM 5.61 ATLAS