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FOR OFFICE USE: ` a-� ... - ------- !2, APPLICATION FOR SANITATION PERMIT Permit No. - ----------------- -•--------------- --------------- (Complete in Duplicate) .__.__.___ This Permit Expires 1 Year From Date Issued Date Issued ...................... ..e; Application is hereby made to the Sail 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. JOB ADDRESS AND LOCATION---- •- -- ----- ---------•- - '-"a(..... =` Owner's Name t `�r��- 5- %- '"`ter• -•----------------Ph e-.1��d 3= �•r t , Address ------------------------------------------------------•••••-------.-------------------_-------- -.�-+: -- -- ----- i Contractor's Name---------------•----" -- �.j•....---- Phone. Installation will serve: 9 Residence �f�partment House ❑ Commercial ❑ TrailerCourt ❑ Motel ❑ Other ❑ Number of living units: _Number of bedrooms -A--• Number of baths _ Lot size,____.....--- :__- =-F= --•-•.--- Water Supply: Public system ❑ Community system El Private W Depth TO Water Table __: ft.y` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑t�Adobe❑ Hardpan ❑ ZW Previous Application Made: (if yes,date--------------------) No [g---New Construction: Yes Q—No ❑ FHA/VA: Yes ❑ No F�- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance from foundation._____,e,rz-------Material--------_ ________ ___ [a/ No. of compartments-________� r=_._..-_Size_.../vt(.y'L �id depth____._-. _ _Capacity Disposal Field: Distance from nearest well_._F---t a__Distance from foundation......!2_ma..___Distance to nearest lot line........--a Number of lines--------------�----------Length of each line------------- ---- Width of trench---------------�------....._ i� i Type of filter material.. � �C.___Depth of filter materiaL____3_____________Total length__-_----______x4st__-0------------- Seepage Pit: Distance to nearest well______________ ______Distance from foundation----------------._..Distance to nearest lot line----------------- ❑ Number of pits____________ g --------Linin material-----------------------Size: Diameter---------------------- - Depth---------••-•----•----•------- _ Cesspool. Distance from nearest well-----------------Distance from foundation--------------------Lining material__.________.._______----_______--....L Size: Diameter---•----------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Eli �j Privy: Distance from nearest well________________________________--------------Distance from nearest building.______-_-________.._._.______--_______..I , 71 ❑ Distance to nearest lot line----------------------------------------------------------------- ---•-•----------••---•---•--------------------- •------- Remodeling and/or r pairing {describe):__ ccs- ---•---- '•-• - ------ .. `'`�__..._�-+7:_2*, ----- p - . -------- -�- - 'r - f ---- i-------------------------------- -----�-----------�---�� -- - �- --------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County -t ordinances, State laws.'and rules and regulations of the San Joaquin Local Health District.,;,, .. (Signed) ------ -----------► --- - ---------- ------------------------------------- -------------------------------------.(Owner and/or Contractor) :.-. --------------------------------------------•-------------------------- By -[rlt e (Plot plan, show q size of lot; location system in relation to wells, buildings, etc., can be placed on reverse side]. \. FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY..--- ` DATE------------ l �`' ------ ,..= DATE_.' - BUILDING RM G PEIT ISSUED----------=----`:,= ----------- -•------------------------------------------------------------- DATE---------------------------` `-------------------------- Alteratians and/ recommendat ns: t.L�t...r .. "`.`, • ------- --------------------------------------------------- -------------------------------------- -------------------------------------------------------- -------------- --•-------------------------------------------------------------------------------- ------------ FINAL INSPECTION i3Y:. ------ Date:. �..3 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5.52 ATLAS `".