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f[, Permit No. ..................... ...... APPLICATION FOR SANITATION PERMIT -.-----•--•---•----•--•........ ..................... (Complete in Duplicate) �� 6 - ----------••----------------- - --------- --- - . This Permit Expires 1 Year From Date Issued Dote Issued __ ...............Z__ 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 com liance with County Ordinance No. 549. 021. —_1620.0'7 JOB ADDRESS AND LOCATION-��Lf,•�rr�vz..t3�':_,�-...1'�'-�,'.-�iU�j _. ....._.,�5�.._C��'tt..t...._.... p D Owner's Name..... ! .:..•. -. a �Yj — t .. .e�l_r 5 . Phone........•---•-•-------•--_--- Address------------•-............ _ ��aa l j --• -- Contractor's Name ---------------- Installation will serve: Residence,M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1----- Number of bedrooms _S_'. Number of baths 3-A-e Lot size Water Supply: Public system ❑ Community system,❑ Private 20 Depth to Water Table _'VP ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam I0 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No X New Construction: Yes Wj No ❑ FHA/VA: Yes ❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) SFptic Tank: Distance from nearest well--17O --•-Distanc from foundation----ZOl-------Material..------ ------------- No. of com artments-_�".._.....,__ �iiae. .. $_ +'�' _:^Li uid de th...__ Capacity-1.2--m.._. Disposal Field: Distance from nears t well-,T0."_.:__Distance from,foundation./V.............Distance to nearest lotline.._�_...._.._ VE Number of lines____-___-_-..-... ength ofleach line? _-t-----s�s�.�---Width of trench.XY_-�731....._-..... Type of filter material�q� 4�Depth of filter;material../�___.-___-._.Total length--..*-.................................. Seepage Pit: Distance to nearest well_........._.......Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits......................Lining material.......................Size: Diameter.......................Depth_............................... Cesspool: _ Distance from nearest well-----------------Distance from foundation.-..................Lining material................................... ❑ Size: Diameter----- -----_------------ -----------Depth....................................................Liquid Capacity...........................-gals. Privy: il. Distance from nearest well..... .... ....--------- I...__..........__------Distance from nearest building............................__......... ❑ Distance to nearest lot line............................•-•--•-•---------------------------------------------------------------.................... ---•---........- Remodeling and/or repairing (describe)-------------•------------- ------------------------------------------------------------------------------------•-....................................... ---------------------------------------------------------------------------.............................................................--........._.._......------•-•-•-------•-----------•...._.....__....._--•---------. -•---------------------------------------------------------•------•-•---•----..........................................................-----------------------------------------------------..........................._ -•-----------------------------------------•--------------------------..................................................................................................................................-------------- I 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 regulations of the San Joaquin Local Health District. (Signed)............ -- -•- t ..---- ------ ...........................•---• ............... • . --------(Owner and/or Contractor( By:._... ----------------(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 • r APPLICATION ACCEPTED .........................�•-- ---....--------- _. _BY. . 6_�._�_ �_�. -_.__... DATE. REVIEWEDBY.---- ----_-------------------•--------.---------------...._.---_ ----- -----------------------................. DATE------_---_--------------............................... BUILDING PERMIT ISSUED......................... .. . y . ..........-------- DATTJyC- ------..----• -A 7C%1f �.'_�...__.-_.. Y.------ `1�.T � ................... AMterations and/or recommencfiations:-... ---- -------...- �.... _..._.. i .-----•------•---------------------------•---- ....._........--------- - ------------ ----•----------................------------------------------------------ ---------------------------------------------•--.•------------••--- ...... FINAL INSPECTION BY: . -_--------------- Date... d ^...?' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stud 300 West Oak Srro*t 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,Callfornia Manteca,Californlo Tracy,Collfamla ES 9 REVISED 0-59 214 8-61 ATLAS