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FOR OFFICE USE: ----- Permit No. ..,lS.-• -......, APPLICATION FOR SANITATION PERMIT --------------- .-----.----- (Complete in Duplicate) Date Issued ... ------------------- This Permit Expires 1 Year From Date Issue 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. I JOB ADDRESS A D LOCATION -----------•-••------- /f -----_ Phone------------------------------------ ------------------------ ----------••-------------------------------------•------- . ---•- ------------••-------------•-------- -------------------------------------------------------- Address -•-- Contractor's Name--------_ - Phone.............._--------••------- Installation will serve: Residence n Apartment House [:1 Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms _5__ Number of baths .___�_ Lot sae ---- �--- ----------- J.40 X Water Supply: Public system ❑ Community system ❑ Private P( Depth To Water Table _l..Q ft. Character of soil to a depth of 3 feet: Sand El ❑ Sandy Loam ElClay Loam [3 Clay C] Adobe X Hardpan ❑ ' Previous Application Made: (If yeJdate----------- -----) No New Construction: Yes Na ❑ FFIA/VA: Yes [I No `,. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I - Material--------------------------------_---------------- ' Septic Tank: , Distance from nearest well-----------------Distance from foundation._-_-....---.__-- -. No. of compartments--------------------------Se---------------•---------- Liquid depth Capacity... I �„�t�'J *O-�._---.Distance to nearest lot inset_ ___-. 40.,p�al Field: Distance from nearest wellWistance from foundation..-_ _ Number of lines-3------- Length of each line. . _ _.-..Width of trench--- r------------------------ m 11 i Type of filter aterial_x -..-----_Depth th of filter matenal--L8 ------------Total length_____jaP_Q-•.-------_---••--- Seepage Pit: Distance to nearest well--------------____-_-Distance from foundation------------ to nearest lot line__-..--_...._-___ ElNumber of pits----•------•----------Lining material---------------------- Size: Diameter------------- ---------Depth------ •-----------•----------- Cesspool: Distance from Inearest well-----------------Distance from foundation-------------------.Lining material--------------------------- -------- ------------- --_-__- Size: Diameter, -------------Depth_----------------------------------- ---------------Liquid Capaci ----------------- ----------- als. -is __-------_-Distance from nearest building , Privy: Distance from nearest we{I------- ------------- ----------- - ----------------------------------••----- ❑ ---•-------•------•----•----------------------- Distance to nearest lot line----------------------- • ------------------------••------•--`---- { Remodeling and/or repairing (describe):------------------------ --------------------------•-------------•-------_---_.-.---------•--•-----------------•-----------•------••-------------------- I -----• ------•-------------•-------•----- -------------------------- --- - - -----• ----• -------------------- -• ------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules a d regulations of the San Joaquin Local Health District. I 0 (Signed)_ t ------------------------------------------------(Owner and/or Contractor) i- -- -- - --- ------�SE� tI�-=------ ------------- - --�----------- ----- Title------------------- (Plot p , showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ! FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------------------- ---------------------------------------------------------- DATE REVIEWED BY---------------------------------------------------------------------------- ------------------------- - DATE---•1-- -�,-5-.97,-423------------------- BUILDING PERMIT iSSUED------------------------------------------------- ----------------------------•-- DATE------------------------------------------------------------- l---- - -------------------------••------------------------------------------------------ -------------•-- Alterations and/or recommendations--------------------- -- --------------------------------------------------------• . -------------------------------- ----------------------•------ _------------- e _ Date------------- ` FINAL INSPECTION BY:._--------- --------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strout 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5.62 ATLAS s" -