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FOR OFFICE USE: I ------ ---------- ------- ---------------------------- o APPLICATION FOR SANITATION PERMIT Permit .. ------ (Complete in Duplicate) /! s -/_.__-- ----------- --- This Permit Expires 1 Year From Date Issued DaO te issued S,l42,?—o —06 Application is hereby made to the San Joaquin Local Heal}h District fora permit to construct and Install the work hereiibed. l This application is made in compliance with County Ordinance No. 549. II JOB ADDRESS AND LO TION_- -` ' � ----------- ---------- Owner's Name _e ._ - - Phone'M ._._. ......................... Address....,_ �1 ... �. a --------- ------------- ` ............................................................. Contractor's Name.. r------ A--------- . -- -- ---- ---._............................ Phone__...... ---•-•--- Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ._____ Number of bedrooms 3- Number of baths ---i(- Lot size . - ___ ___ ______________ Water Supply: Public system ❑ Community system ❑ Private Depth ' Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FH /V Yes ❑ No ❑ �n TYPE OF INSTALLATION AND SPECIFICATIONS: V� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well_________________Distance from foundation-------.............Material--------------=................... .____.__..-..: ❑ No. of compartments----------------------•--Size---------------------------------Liquid depth---••---------------------Capacity----------------- -- Disposa geld: Distance from nearest well from foundation.....E_0---------Distance to nearest lot line__-�....... . .i, ` Number of lines_________________________ Length of each line------��__�___.jj-_...Width of trenchM_.... ---------------------- Type _`...._.-___ ' r T e of filter material-_..- De th of filter material_.____ Total length____..:[,.a_______________________" 1 n Yp p Seepage Pit: Distance to nearest well----------------------Distance from foundation___..........=:=Distance to nearest lot line- _-__________-, i ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_--- Depth-----------------..__....--____-- ! Cesspool: ; Distance from nearest well-----------------Distance from foundation-------------- Lining material............___--.....___________-_-_ .Liuid Ca act ❑ � ' Sae: Diameter--------------------------------------Depth------------------------------------------------- q p tY k------------------------.._gals. Privy: 1 Distance from nearest well-----------------------------------------_------_Distance from nearest building _____ __________..__-_________________- ❑ Distance to nearest lot line------------------------------- --------------------------------------- ..-.__..... 4 Remodeling and/or repairing (describe):---__�f, -- - F . ----------------------------------------------•-------•-------••----------------.--------jun ,� -----------------------------•---------------- ----- 1M f I-hereby. certify that I have prepared this application and that the work will be done in accordance with f San Joaquin ordinances, 5t laws, and rules a re tions o the San Joa uin Local Health District.�(Signed) ---------------------- ��' �' and/or Contr I By: ' y -(Title). -:--- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY - - ---------------------------------------------------------- DATE - ' --•-•----- --------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-------------------------------........... BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------- --------- DATE--------------------------- Alterations and/or recommendations:-------------------------- ------- ---------- -- ----------------------------------•--------•-•-•-----.---------------- -------------------------------- ----------------------------- ----.--•--•------------- ----•--•--...... -----------------------------------------------------------------------------------------•-------.-..-----------------------•---------•--•----=' -------- i 0 FINAL INSPECTION BY: -- �� Date_ .- '. T� I� � .F SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5.62 ATLAS i _ .l