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-- --- FOROe-1 Or CE USE: 2-- --- ----------------------------------------------_----- APPLICATION FOR SANITATION PERMIT Permit No. ..--.-_---•- -_--- --------------•--- ---------- ---------------------•----- (Complete in Duplicate) Date 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 described. This application is made in compliance with County Ordinance No. 549. r JOBADDRESS AND LOC TI N.:---- 5--•--- :- /l ------------------------------------------------------------------------------------- Owner's Name .. c ---------------------------------- Phone.- Address...•--•----------------- . '`1 . . - -- ---- - Contractor's Name------------- ------- Q7. ... _ ---...... Phone---.............. ------------ �...................... ............................ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___. Number of bedrooms ._/. Number of baths ...I_ Lot size ____-_� l_5___—--------------- Water Supply: Public system ❑ Community system ❑ Private 1Z Depth to Water Table ________ 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--------------------) N6`,4 New Construction: Yes ❑ Nojj, FHA/VA: Yes ❑ NOX TYPE OF INSTALLATION AND SPECIFICATIONS: 1 n (No septic tank or cesspool permitted if public sewer is available within 200 feet.) c!!� Septic lank: Distance from nearest well__ Q ...Distance oun ... _f ..__.MateripI--•___) ----------------------------- )Z1 ______...................:. No. of compartments______�—_.-_ Li uid de th...._.y_/--__________capacity . . ...... r Disposal Field: Distance from nearest well__,�L1/_Distance from foundation ___/6___ Distance to nearest lot line 5.4...... Im Number of lines..------------ Length of each line_____________ j t1........Width of trench-----------2-------------------- Type of filter maferial Depth of filter material___� _ __ ____ r__ Total length................ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line.........._,�✓ IV% ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------.--.----.--.---.Depth-------------.__-..______---.... Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material----------.--_.._...---------------If ❑ Size: Diameter Depth ----- ----------------- Liquid Capacity............................gals. v Privy: Distance from nearest well-----------_-------------------------------------Distance from nearest building__________--.__---.-----_._____________._. ❑ Distance to nearest lot line ----------------------------•-- ---- -------•--------•----------•---•------------ l Remodelingand/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, St to 'aws, red rules and r�egula to of the San Joaquin Local Health District. (Signed).'__... -- -----------------------------------(Owner and/or Contractorl By:.................................. ---------------(Title)------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be,placed an reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY---------- - -- --- - ----------------------------- ';.DATE-- o� REVIEWED BY--- -------------•------------------- �`fDATE............... _._... BUfLbING PERMIT ISSUED. -------------•..............•-•....------------'DATE.-----------------------------••---- Alterationsand/or recommendations:..----_-•---•-•- ---------------------------------------------------------•---•---- -i-----.------------•---•-----------..-.---•-------------•------------- --------------••----•---••----•--•--••-•---------------------------------------------------------- -------------•-•--------------------• -•--------•-=-------------------.--._....-=--------------=...................... t 4 w - r FINAL INSPECTION BY:.- ----•----- --------------- ---- Date -�� 5 S N JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak Street 124 Sycamore street 205 West 9th Strout Stockton,California 1.6411 California Manteca,California Tracy,California E89 REVISED 0-59 2M 6-6[ ATLAS'