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-------•----•---------------_---. -----.- � _ _ &'uLICATIONti -------------------------------------------:----_---_---. FOR SANITATION PERMIT Permit No. .,l_��1 .l...l - ------------- -------------------------------------- (Complete in Duplicate) -------------- ----------- ----------------------------- This Permit Expires 1 Year From Date Issued Date Issued .... y Application is hereby made to the Sen 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. e JOB ADDRESS AND LOCATION...CR..l�7_thQ - ._-..-. ,, ............................... Owners Name................- -- ..................................................... Phone....AddressZ........ r f '_ --•- . ....................•----....--••--•••-_.... Contractor's Name ---------•-• ....... -------- •---------------- Phone................................... Installation will serve: Residence Apartment House // Commercial E] Trailej Court ❑ Motel ❑ Other ❑ Number of living units: ...I_-- Number of bedrooms ....t. Number of baths --- Lot size ...../ Y Water Supply: Public system ❑ Community systemPrivate ❑ Depth to Water Table � _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam ❑ Cley Loam ❑ ClayAdobe❑ Hardpan Previous Application Mede: (If yes date____________________) No New Construction: Yes No ❑ FHA/VA: Yes [I No TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-.3P TDistanc - ro oundati n-•---L .........h t is .. { No. of compartments_---_-4-_--•--...__.-Size_._.. �� l X_ _Liquid depth.......... •. Capacity.... Disposal Field: Distance from nearest well__e3r('Distance from foundatio _.._1_A2 _.._.Distance to nearest lot line._. . Number of lines_.._-...I..5_. ____ Length of each line...... :_a Width of trench.__.....2,�-.��----.-...--. q ry Type of filter material._..._ .___.____4Depth of filter material___..�13 __----_._-Total length......10.-----.•--_ -11 Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line.._......__._..._ lZr ❑ Number of pits--.-_--__-_-___-._Lining material----------------------- Diameter._____..._..._......__..Depth__...._........__.._..._..._ Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material..................................... ❑ Size: Diameter Depth ------------------•----- Liquid Capacity gals. vN Privy: Distance from nearest well-----------------------------------------__.___Distance from nearest building _________ _____❑ Distance to nearest lot line------------------ .......................... . Remodeiin�r repai ing ( escribe):--- :.. . . --..•-------------- ---•. .....------ 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 SaSan Joaquin Local Health District. (Signed).-.'J< y------..%-4 ~----------------------•---------------------------•-------------------(Owner and/or Contractor) By:__...•---•------•-----••--------------------•----•----------•--•----•---------------------------•------------•--------------------- Title ft-* (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can b"laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------____---------- DATE_..__._..._._ -------------- .......................... DATE_BY DATE- -;/ �= BUILDING PERMIT ISSUED ` .-•--------•- •------------------------------- DATE-------•----------------------------------------------.----- Alterations and/or recommendations:.... -------------------------------------------•-•---•-------•--------•-----•----------------•-------------------------- --------------------------------•---------------•--------------- •-•.............••----••. FINAL INSPECTION BY:..------... -- - ----•------•-- Date........... ...... . 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 8.89 8M 5'61 ATLAS 4!'`.y`