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FOR OFELE USE: r _.__ ------ '`APPLICATION FOR SANITATION PERMIT Permit No. 's � --- ` - (Complete in Duplicate) -------------------------S'1-].--___._. This permit Expires 1 Year From Date Issued Date Issued ..... _L.3.___ Application is hereby de 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. ` JOB ADDRESS AND LOCATION--------- --•-------•- _0------------P/--------'------------------------------•---.-.. Owner's Name.........s/A_0, --------4'_Fas_e------------------- -------•-••--------------- ----- ---- -----.......I------------------- --.. Phone-- Address............-j... �?7.- ' ------------------------------------------------.- Contractor's Name---..D..: f s 1 .. :......... Phone E• C 7_ Installation will serve: Residence [tom Apartmentlid use ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___�___ Number of bedrooms __-� _ Number of baths __ Lot size .___�s_5 .___X..___1.: . ..................... Water Supply: Public system Community}system ❑ Private ❑ Depth ro Water Table -------- ft. {� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe[Hardpan ❑ v Previous Application Made: (If yes,date----------#---------) No ET New Construction: Yes ❑ No [T"_FHA/VA: 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---------------._______._..--.-....____-.-..__... 1 ❑ No. of compartments-----=4- ---------------Size...................•............Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well-_1A/AAV,.`Distance from foundation,...p 4-�_3_ i nce to nearest lot line..... ._..._. ® Number of lines_____________ --------------------Length of each line__________-'�___-___�________- I th of trench.-._.._...sr2.`?�.............. aefq Type of filter material....R_-?`/C------_Depth of filter material----/_?-----------Total length................ _-_---•-___--___- Seepage Pit. Distance to nearest well---IVVWr,-_Distance from foundation-----1.A'--_-.Distance to nearest lot line._..-.!�7---_-- [ Number of pits....../-------------Lining material---_ Size: Diameter--------- -_Depth---------9-(Li------------ c 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---------------------------------------------------------------------------------------------------------------------------------------------- 4 Remodeling and/or repairing (describe)------------ ------- ----CXi 7l ------3'P'S�t'V........ . ----------------------------•--------------------------------------- r'------•-------•----------------------•-----------------------------------------••---------------------------------•-------•----•-------------- 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 rules and ie gala+ions of the San Joaquin Local Health District. (Signed)... -:-.:... --•----------------------------------------(Owner and/or Contractor] op By:............... `----- ---------------- ----------------------------(Title)---------- ----------------------------- (Plot plan, showing size of lot, locatio• of system in relation to wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -:- - --------------- --------- --- BATE-___ -.!3 -b - REVIEWED BY--------•--------•--------------- i ---------------------- DATE---------_-.------ BUILDINGPERMIT ISSUED--------------------------------------------------------------_-------------------------------------- DATE------------------ ---------------------'------------------- J s� tom...._. �.-- -_.--�--• -1A " = s ' f----� ----------_------- Alterations and/or ecommen ations:.- .. .l �----- -- ---- ------ --•--- • ......... .. .. .... ........ 9 �- ----•--- -- /... -------------------•----•---------------- --•---•--------------•--•----- --- ---•-••--•--- e FINAL INSPECTION BY:..... AICA -------------------- --y------ Date... .-.1 _-- -- ---•- ------------------------------ SAWJOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lad[,California Manteca,California Tracy,California E5 9 REVISED B-59 ZM 5.62 ATLAS .r