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FOR Coma USE: rho l�- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..... ..., ------------------------------------------------- --•-- (Complete in Duplicate) Date Issued _._. X.�I..--------------------------------------------------------- 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. JOB ADDRESS AND LOCATION., --, ------'�> aZZA ._...... Owner's Name �...�J ' -------------- ----------------------- --- Phone.................................... �-- c..... /� Address-_-�Io...s�1. .--C&A."-----...�• ....................... Contractor's Name--•-------------------------•------•-•--•-------------•-----------•--•-----•----------------------------•-•------•---....•••• ----•••..•••--- Phone................................... Installation will serve: Residence (Y Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms ._'Number of baths ---L Lot size ..... .c2_,e�'./.O.L?........................... Water Supply: Public system ❑ Community system 1� Private ❑ Depth to Water Table .�$. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ( Adobe Hardpah Previous Application Made: (If yes,date--------_-----------) No N New Construction: YeSA No ❑ FHA/VA: Yes ❑ Noe" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellQ'i��istan from foundation....LQ..........M�a�terial... {°................ No. of compartments____�r'................Size..� �_0__�C..S..._Liquid depth_....4...r .........._Capacity.../y.O� Disposal Field: Distance from nearest well . (stance from fou dation....157 Di a to nearest lot line..-�_...... - fp� � Number of lines___ •--•----�______ _-- -_Length of eaI�i lifle?."30-��_3_ Wi'clt of trench.i`Z ......................� �� } t Type of filter material._ ._.i'.r_DepDepth of filter material____-12._._____.__Total length.....��-_�......................... Siiiepa§e 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.............................................------Liquid Capacity--•-----------------•-.....gals. Privy: Distance from nearest well______-------------- __Distance from nearest building...... Distance to nearest lot lin ------------------- - -------- ------------------------------- •-----------... Rem ng and/or re (descri e ' i!._l.4_ ._ ''�a_ ._....-�r� /Y --'-�-� '" C •••. --•----------------------------•---•---------••-------------------------------..._.....----------------•-•----•--•----•-------------------------------......-•----............----------•----•---• •--------------------------------------•------------................................................•••-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 0 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)......eL,._�r�'r. �Jl ------------------•------------------------- (Owner and/or Contractor) BY:--•---•-----------•---------•......................•-----. ..........................................................(riitle)-------------------------------------------- -- -------------- (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 = DATE------------------------------- REVIEWED BY............................................................... ---------._.. DATE......... -�-/ .�`'"'' - _ �. ._........- BUILDING PERMIT ISSUED • - s - -------------------- DATE.----------� -----•---------------•--------........---- Alterations and/or recommendations:----------•---------------------- ------- --------------------------------•---------------•-•------------•--------•--------•----------•-----••-•---------• .....................................-.............._......................................................................................................................................................................... ..-•---------•---•----•-------•----------------------•-•---•---•--•-----------------...----------------------------...-----------------------•--------•--------•------•--•------------•-•-•------... ......................... •--•--------•--...••••--.....••-•----------- ---•-•-•---........ ...----.... -- ----• ....... --......-•--------------------------------....------•-••----------•---......--•--....---------......-•--•......... FINAL INSPECTION BY-------------- ---------------------------- -- / Date....------------� ...... /..................................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strut 124 Sycamore Street 205 Weft 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E69 REVISED 0•59 RM 6-61 ATLAS 1: