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FUROFFICE USE: 4. .a --------------------------- ----------------------------- - - ------------------ -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...�.�4 �. ------------------------------- ------------------- (Complete in Duplicate) L �- ------------ ....... This Permit Ex ires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Loca! 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 AN LOCATION-----�PZt--------- 6S .FH---------------------------------------------1�1ANY_�C __.._ r� / ; - Owner's Name------ .�R-�-----_----... 1 .``�_ ------------- Phone.................................... Address........ ... _ r Contractor's Name--------�2WIN Phone ---------------------- -- Installation will serve: Residence Apartment House ❑ Commerciale❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. ._----- Number of bedrooms .-.Number of,bats --- --- Lot size ------ -X__.115.- ------------------- Water Supply: Public system E] Community syst m [IPrivate �epth To Water Table -5-- ft. Character of soil to a depth of 3 feet: Sand eGGravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------- No VT'� New3Con truction: Yes ®'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: , Distance from nearest well-----------------Distance from foundation___________________Material______-__--___._-_-______------...___-________-. I✓ `i�r N No. of compartments Size ------------------------ ------------ -=-- Liquid depth--------------------------Capacity t Disposal Field: Distance from nearest well- ....Distance from foundation---,1_1........Distance to nearest lot line_..)_..___.. Length of each line`k_..-_.��7_�------Width of trench...._ b_f�....... � .......... Number of lines----------- ;}__ g Type of filter material.._.. -Depth of filt,& material___/.-, .---,_____Total length--------- ?________________________ r Seepage Pit: Distance to nearest well----------------------Distaiice from foundation---------....F._._.Distance to nearest lot line....._-_.___-____ U� ❑ Number of pits.---------------------Lining material----------- ---------.-Size: Diameter-----------------------Depth--------------------------------• Cesspool: Distance from nearest well-----------------Distance from foundation ________ .Lining material...-.___.______________.___..._.____ ❑ Size: Diameter--------------------------------------Depth------------• ------ -'A 4�%1f s � --------Liquid Capacity--------------------- -- 9 aIs. Privy: Distance from nearest well------------------------------ ----_---I ------Distance from nearest building----------_-_---____•_________.__..__.___. ❑ Distance to nearest lot line------------------------------------ --I Reodeling and/or repairing (describe)------------------------------------- ---- =---------------•-••------------- ..-----------------------------------------------•--............... 4,Z�_ v---- ��_ 1—Ze C .._-----•--------------------------------------`•------------------------------------- -Mi A. - — ------------- - ---------------------- ----------------•-----•----•--------------------------------------- --- 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 'rulesand regulations of the San Joaquin Local Health District. (Signed) ' ' + ---- -- (Owner and/or Contractor) By:......------------- i •---------- ------------------------------------ ------------------------------------(Title)--------------------------------------- -- -------------- (Plot plan, showing size of (of. location of system in relation to wells, buildings, etc., can be placed on reverse side). -y- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 > '--------------------------------------------- ----------- DATE- `._:_•----------- REVIEWEDBY------------------------------------------ -------- ------------------------------------------------------- •-----•--------- DATE BUILDING PERMIT ISSUED--------------- ------------------------ -- ; : ............... DATE---------_-----•-....... •---------------=_ Alterations and/or recommendations-------------------------- ------------ --------1 ----•-••-----•---•---------•-----------•---------------------•- ---- r ---------------------------------•---..- ------ ---•--------------------------------------------------------•-------------••--------------------------------------------- w., -------------------•--•----------------------------- --- --------- ----- FINAL INSPECT! c - 7 Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-42 ATLAS