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-�- FOROFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMLT� - Permit No. �... . --------------------------------------------------------- Complete in Duplicate} r1 } Date Issued _11, -_ This Permit Expires 1 Year From Date Issued .._..---_-_-••-.-•..1� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 4; This application is made in compliance with County Ordinance No. 544. �� c JOB ADDRESS AND LOCATIO --. _y --- .- _� N- � - � Owner's Name----4,,/i'z !.l P� f 'f`-;----- -- -------------•-•-------- --------------. Phone + Address. - s�•� ----�.:.--- ----------- ----- --------------------------------------...------- r Contractor's Name., ..........LA------------------------------------------------------------------------------------------------------------------------ Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ,M Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1...... Number of bedrooms_-_. Number of baths . ,,_. Lot size .... __f.F�. .•......................... !I Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table ' .. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam N Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made:!i(If yes,date---------------- No E] New Construction. Yes `50 No [3FHA/VA: Yes ❑ No ElI+ " TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) n � •; Septic Tank:. Distance from nearest well--S- 5_-----.-_Distance frgm foundation .r__.....--.Material.... .-_- - •............................... r: No. of compartments.-- -----------------Size-_1:_s ..__..v_-�_� 6 Liquid depth...... -----------------Capacity.? ------------ r" Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line................. f ❑ Number-of lines-----------------------------------Length of each line-----------------------.___.._Width of french-------------------------.--_---.-- Type offilter material—_•-------__-__---_-Depth of filter material----.___.._-..__-_---Total length.----------------------------•_.-__._.__-. it Seepage Pit: Distance to nearest well--------•-------------Distance from foundation....................Distance to nearest lot line__--..__-------.- , ❑ Numberi of pits----------------------Lining material-----------------------Size: Diameter------------------_--Depth--------------------------------- 4 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..-----_.---.-_---...._•_----..--.-. ., lSize: Diameter------------------ -------------------Depth----•---------------- -------------------------- Liquid Capacity----------------------------gals. l Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.-.-....-..-_-.__---_-_--.-. ❑�: Distance to nearest lot line----------------------------------------------------------------------- -----------------._...---•---------------------•-•-------------------• Remodeling and/or repairing (describe):_-�i . _, ---/-' L /..... ?'! ---------•-•--.......................... ---------------------------------------------•--------------•-----------------------•--------...------------Z--•----....-------------•--.....__...-------•--•------•-------....-•••-----_--. V 4 .....-------------------------------------------- '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 and regulations of the San Joaquin Local Health District. '/ --:-•--• ----------------------------------------------- _ -_.--.--.•---------------(Owner and/or Contractor) (Signed)----------------------•--. .. -.;--.�---��------------ -------- � • By:---------------- •-----.ii-------------------------------------------------------------------------------------•--•-•---------trifle)--------------------------------------------- ------ (Plot...plan...showing size of-lot, location-of-system-in-relation ao_wells,=buildings,_efc.,4an be-placed-on-reverseside). --^^ +� FOR DEPARTMENT USE ONLY li, APPLICATION ACCEPTED ---------------- -------•-••------ : DATE-_//" -7'G . -` ------------- REVIEWEDBY----------- ----------•------ -------------------------------------------------------------•-•- •--•------------------ DATE.................. PERMITISSUED---------------------------------------------------------------------------------------......-------- DATE-----------------••----•-----------------------•--•-------- Alterations and/or recommsendations:-------.-------------------------------------------------------------------------------- --------------------------- ---•-- -------------••-----------------------------------------•------------= -----------------------------------------------------------------------------------•---•------------ i -----------------------------•---...---------- ----•---------------•---•---------------------------•------- ------••-• ----------------------------------------------------------------------------- -----------------------------------•- ...-------------------------------------------------------- -----------•----•-•----------- �i FINAL INSPECTION BY. .-.-.- . - . -ter �-----..--.-_-.._ /-�7- I -------------- SAN JOAQUIN LOCAL-HEALTH DISTRICT 130 South American Street, 300 West Oak Street 124 Sycamore Street 205 West 9th Street 4 Stockton,California Lodi,California Manteca,California Tracy,California � � r ES 9 REVISED S-159 21A 6-61 ATLAS i