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p FOR OFFICE USE: ----------------------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. _-•--I......._....... ---------------------- ------ (Complete in Duplicate) pate Issued - This Permit Expires 1 Year From Date Issued ...................�-�- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549 JOB ADDRESS AND OCATION._ �"� ' '° r { ' Owner's Name----- 1•f l =---------� ---------- ----------------------------- ----------------••------_- ------------.-_- Ph6ne .. ......... AddressP X ------••---------------------•-----••--------------- -----------------------•- ------ - f Contractor's Name..___ ------------------------ - --�•� ' Y --•-••- Phone---------------- ------------- !�- '�� '---------- hj Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �p Number of living units: I..... Number of bedrooms __2r Number of baths ...1___ Lot size ____ -¢�......•-•-------------- � Water Supply: Public system ❑ Community system ❑ Private 2-1:r pth to Water Table W ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date____________________) No-Ca-/New Construction: Yes [0-14o E] FHA/VA: Yes [I No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within X00 feet.) Septic Tank: Distance from nearest wel!_ T 7:_j Distance fromTfoundation___�_b.�______-Material....-t'' -.!.................... r P ' a Li uid de th-_..-�-___ . ___ Ca aci L?Q. No. of compartments s---------- -------- --size...G- ----- ••- q P. P tY e . . Disposal Field: Distance fromfnearest well_._�Q_--_Distance from foundation....,t_�.........Distance to nearest lot line....,... 1 - Length'—of •.r..------------- Width of trench. ...Number of lines------ - 1-- -•--------- each line Type of filter"material...FZ1(t �__---_Depth of filter material____1j-'1--------Total length......—......__._r____�____________._._/..._ _! { 4 l �•y r P ! Seepage Fit: NumDistber of pito ts res well._I* I*�.g mDte as e.fro�m ndSize:nDiam�r--.....�n��ce;oDepth----- .� �---•.. I r 4. 4 r �� Cesspool: Distance from nearest well-----------------Distance from foundation----------______.__.Lining material______-._...________......._.__.-- ❑ Size: Diameter---- '--------------------- ........Depth`...--------------------_-T-----------I----- Liquid Capacity-_--------------------•--gals. 1 y w I i -Distance from nearest building Privy: Distance from nearest well--------------------- ------------------- - --- � 9------...----------•-----••-----•--•------ ❑ Distance to nearest lot line----------------------------------------`----------•----------------•---.-_............•----------•--------.....---•-----------••----------•--- Remodelingand/or repairing(describe):-------------------------------------------------------------------------------------------------------------------------------------................... ....-•------•----••-•--•..........................---••-•----------------------------•-•-•--------------•----------..._. ------------------------ ----------------------------.-....-------•------• -------._.. f ---------------------------------•-------.._.................... t • - -----•---------------------•-•---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou ordinances, State laws, nd rule and . gulations of the San Joaquin Local Health District. r t --------------------------Owner an r�Contractor IL (Signed)..........A ... By:......-•-•-----------------------_-----------------_- ----- ------------------------{Title] lG�y ` (Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side). , FOR DEPARTMENT USE ONLY T - \.� r APPLICATION ACCEPTED BY'. ------ - - ---------------------------•--•-------------... DATE _.... `�a-----------------•-------------- REVIEWED BY---------------------------- -- --- . ..------------- DATE BUILDINGPERMIT ISSUED------ --•--------------------------------------------------------------------------- DATE-----..•---------------------------•-----•---------•--------- Alterations and/o recommendation : .-• -------- IW �... ...0- 7`n------------1- c --- - _ -- -v - s--j- :........... :.__. . FINAL INSPECTION .— ....�— Date....... ------------------------- :)SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West oak Street 144 Sycamore Street 405 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REV18E0 8-59 ZM 3.61 ATLAS