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FOR/OFFICE USE: 3/ f �� •_ --------------------------------------------------------- ?APPLCATION FOR SANITATION PERMIT Permit No. ..... --- -------------------- -------------------------------- (Complete in Duplicate) Date Issued - This Permit Expires 1 Year From Date Issued }},�� ------- g __:"............. 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 incompliance with County Ordinance No,549•_ /-.7- 11?G_p 2, I . JOB ADDRESS AND -LOC- TION:_ Owners Name-------------- 'T!v --------------------------------- Phone. - �,�- � Address ------- ---- — ----------•-.... ' .... r-------------------------------------------------------------------------------- Contractor's Name - " .... Phone--------•--•••-•.............•-•--- �� Installation will serve: Residence Ap�r+men House ❑ Commercial ❑ Trailer Curt ❑ Motel ❑ Other ❑ qu umber of living:units:- *a(;Numr of,bedrooms -------- Number o baths .--�-.. Lot size _..------ ...... --------------- Water Supply: Public sy�s#e� ❑ ComiTiunity system ❑ Priva�� Depth-TO Wafer Table ft- Character of'soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0-*"Hardpan ❑ Previous Application Made:-11�f.y�,ess'd toe --------- -- ...... No New Construction: Yes �No E] FHA/VA: Yes [I No tt 4 ; f y TYPE OF INSTALLATION-�A�ND SPECIFICATIONS: (No septic tank or c&rpool ppeer'r�mi fed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest,well----_ -_--------Distance from foundation._----------------Mterial---------------- _-----__.-___---------------- /dt mC � N&..ofltom arf"ents�---- -1--------------Size------__••--------------------Liquid depth Capacity , ' ,l� -----Distance to nearest lot line nDis osal FieldFVJJDistance frd nearest wel!_-- -.-Distance from foundation.--. ------- 11 +�. �l'"Number of lines---------------- - - - �_ Width of trench----------cA. -------------:---- " � ,- � e�: �- .Length of each line_._-------- �---�.r r � , s Type of'filter-material.-.- if- Depth of filter material------li ----.---Total length------------- ....-.-----------__-- C" I *� ^%. wa crt -r-+ �+� ti fel,. Seepage Pit: 'Distanee,t-o nearest well---------------- *"—Vstance from foundation-----...............Distance to nearest lot line.........-------- V► ❑-- Number of pits----------------------Lining material....------------------ Size: Diameter-------------- ------.Depth--------------------------------- Cesspool: Distance from nearest well--------------_-Distance from foundation.------------------.Lining material-------------- ---------------------_ ❑►cJ� Size: Diameter--------------------------------------Depth-----------------------•----------------------------Liquid �apacity-----------------•-_-•----gals. 1 Privy: , { Distance from nearest well---------------------------------------- ------Distance ftom nearest buil ng------_----.-----__----__---_--_---------. yrr ----------------------- r Distance to nearest lot line------------------------•--------------------------_._---•-----------•--•------- =Remodelling and/or repairing (describe):-- ------_-----L----------4-----7 °'4� � -------------------------•---- 3 *' ; '' --------------------- ------ 9+ ------------------A-------------------------------------------------//// {' / ------ ---------------------------------------------------------- 1 .� 4 ----------••---- ,'------------------ -----------•----------•-----•----•------•-------------------_----------- --••-•-----------------•-•--•------------ - I hereby certify that I have prepared this applica+ion and that the work will.be done in accordance with San Joaquin County ordina es,' State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) = -C" -- ----- � ---------------------------------------------{Owner and/or Contractor} ' r+le B . , ---- { - (Plot an, showing size of lot, location system,ir elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - - DA7E .. APPLICATION ACCEPrTE B---- F -_ .- `�`� REVIEWEDBY-----..�`•--------•-•---------------------------------------------------- ----------------------------------------------- DATE----------------•--------- . �_. --------------------------------- BUILDING`PERMIT ISSUED...........----------------------------------------------------••----•----------------------------- DATE_--------------------------- ------------------------------- Atterations'and/or - - Alterations'and/or recommendations:_.------------------------------------------- -•-------------------•------------------..•---•----••----•-•-----------•-•-------,-------•--•-------------- ------------ =--------------------------------------------------------------------------------------•----------------------------------------------------------•-------•------•--------_---.--------------------------. t ----------- ----------------------------- --------------------------------------------------------------- ---------------------- ------------•-----•-------------------- --- ----------=--------1---••------------------------- -------------------•-- ----•-------------------------- -•-- ---------------------------------------•---------------------------------------------------.............. FINAL INSPECTION BY:....-- ------ - -------------------- Date------- ` 4.14- --.------------------------- ..... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strut 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi,California Manteca,California Tracy,California f ES 9 REVISED 8-99 2M 5-62 ATLAS