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rUKvrril,t Ubt: ------------------------ -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -.4...........,..� (Complete in Duplicate) - --------------------- This Permit-Expires 1 Year From Date IssuDate Issued ssued ___.7 _/l_I r Application is hereby made to the San Joaquin Local Health District for a-permit to construct and install the work here i de red. This application is made in compliance with County Ordinance No. 549. O ( —p �f -2- 13 5_1 6 /V j, 9 a JOB ADDRESS AND LOCATION.__If. Owner's Name.... 40..i ---�------------------ --'-- ----------------• Phone....................................` Address �7 - ----- ----•---- ---------- -------------------- ----------------------- � Contractor's Name_________... ------------------------ Phone................................... 1 Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t t Number of living units: .1----- Number of bedrooms Number of baths j--- Lot size _____________________ � ----------- Wafer Supply:. Public system ❑ Community system ❑ Private 0 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑I Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material......................................... _...... ❑ No. of compartments---------- -------------•-Size-------------------------------Liquid dep h-------------- -----------Capacity.......... Dispose eld: Distance from nearest well...i:Td-----Distance from foundatio -__�f�__: ----.Distance to nearest lot liner. t� 1 Number of lines--'-fi-- - - •------------ -----Length of each line_-_.._ _. 3--• '•-------Width of trench----7../--••__-.-.-..__.--.--- s Type of filter material....A"._-Depth of filter material____./F!------Total length......... ______________________ Seepage Pit: Distance to nearest well---------------------- from foundation-------------------Distance to nearest lot line---_.___-__-__... Number of pits----••----------------Lining material-........--____-------Size: Diameter-------------------------Depth-----------------•--------------- i Cesspool: Distance from nearest well-----------------Distance from foundation-___________.____.-.Lining material-._.-___-_-.-__-__________----_-.____ ❑ Size: Diameter---' -•-•---------------- •---------Depth---------------•----------------------------------Liquid Capacity-------------_-------•---gal`' . - Privy: Distance from nearest well------------------------------------------------- from nearest building--------------_________---_--._.______.._ Distance to nearest lot line - e Ing an 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. 5t ned � � �"` • { ig )----- i ; ......r -...__... k truer end/or Contractor) By: .... tt ' _..(Title)----••-•----•------ . - - - e (Plot plan, s owing siia'of1ot,'lacation'of sistern in relation to wells,buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --------------------•----------•- DATE_ i REVIEWEDBY------------------------------------ •------------------- -------------•---•---------------------------------•-••------------- DATE---------•--•-------.............. BUILDING PERMIT ISSUED------•--•-----ti---------------------------------------------------------------------------------- DATE Alterations end/or recommendations:----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- -� --••-•---------------------------------------------------------------------------------------------•---•----------------------------------.-.---•----•------------------_-._--.---------------------------•----------------- l ....._..................'----- ------ --------------------------------------------------------------- --- -•--------------------------------- -----------------------------------------------............:-------• I d FINAL INSPECTION BY:,/..,.;Z !� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 206 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-99 aM 5^61 ATLAS