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e� FOROFFICE USE: � 000(a __----------- ------------------------------------_ APPLICATION FOR SANITATION PERMIT Permit No. .� �f:;f_,/= (Complete in Duplicate) t ------------------ This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS A LOCATION.-_-I•-. ...6...... ----- Owner's Name-- +u ... . ....... .... ----- -------------------------------------------- ---- Phone............... Address � �� - - tQ •----... ...._ ------------------------- Contractor's ______ _____________ Contractor's Name =_--•'. ----------------•--- •-••---• . --•-----•---------•----•-••-•-. --=•-=-- . •-•-•--....----- Phone. ................................ Installation will serve: Reside6ce91 Apartment House ❑commercial C] Trailer Court C] Motel [I Other [INumber of livinej.units: _.�-_-- Number of bedrooms ________ Number of baths -----L Lot size .J___________________________ Water Supply: Public syste" ❑ Community system Private ❑ Depth to Water Table /.;-,ft. Character of soil to a dept"3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam:❑ Clay X Adobe❑ Hardpan Q Previous Application Made:``1If yes,date--------------------) No New Construction: Yes PHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 7 (No septic tank or cesspool permitted if public sewer is available within 00 feet.) Septi! Tank: Distance from nearest well Distance from foundation........,, __..Material................................................. No. of compartments---- ----- ----------- 'ze-------•------------------------Liquid depth..........................Capacity....................... i oral Field Distance fra6 nearest wel__________ _ __ nce from foundlati9� / __ __. lstance to nearest lot Number of lines*----- .____. Length of each line' . gWidth of trench....._. ..� Type of filter material.�_��''_.... . .Depth of filter material-__--.. ----_. P :Total length-._.._1_ Q..................... Seepage Pit: Distance to nearest well____-_-__•..•__-_----Distance from foundation....................Distance to nearest lot line................. \� ❑ Number of pits......................Lining material-------------------__..Size: Diameter.......................Depth................................. Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material..................................... ❑ Size: Diameter---------------------------------------Depth............-•---•------------_---------4------.-Liquid Capacity............................gals. Privy: Distance from nearest well------------------------------------------------Distance fro; nearest building.......................................... Distance to nearest lot line, -------•................. Remodeling and/or repairing (describe):------ - - --.---/ �rr� f. .-- .....................................................................................................y.................................................................................................................... ---•------•-----•-------•---•-•---------------- •---------•---------•-----•------•-----••-----•--•--•---•-------•-----•------------•-•----•-••-. --•---•--••----------•----------•------•--•-------------------._.--_- I herebyY a if that I ve prepared this application and that the work will be deme in accordance with San Joaquin County ordinances, St a ws, a ales and regulations of the San oaquin Local Health D10rict. (Signed)..-• y --------------------- -----------------------------(Owner and/or Contractor) -- ------- ..... .... rifle --- --.............................................. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... ................=1 ------------------ ----- -- ---- DATE -•-•---•-- REVIEWEDBY....................................................................... ----- -••----- ...................... DATE------..J'7,... �9 BUILDINGPERMIT ISSUED............................................. --- --- -- -------------•---------- DATE.................................... . Alterations and/or recommendations----------------------- ------------------------------------------------------ i ------------------------------------------------•-----------------------------......-------------------------•----------------------------••-----------•-------•----------•------------•-•-•-•----•--•--•---------_... ----------------------------•------------_.------------------------------------------------------------------------- FINAL INSPECTION BY--------- ---------.....=- C�L Dete.... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wort 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E8 9 REVISED 8.89 tM 8-61 ATLAS