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�FOR OFFICE USE:/ � '- \fi . s ---------------------1 ----------------------- 'APPLICATION FOR SANITATION PERMIT Permit No. _�s. •-- . ------ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .... ........ ..... taw iso -�� 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. 3 VU uMOiN�. JOB ADDRESS AND LOC TION....::' _ - Owner's Name___ F --------------------------------- -----------------------------=------------- Phone-----------------•-............... -• ..r Address - ------ ................................................--•--------------------------•-----•-------------------------.........---•---------•-•-----------•---••------- Contractor's ------rzs---------------------------------------------.---------------------------------------------- Phone................................... -installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ 'Motel _❑ Other El— Number of living units: -------- Number of bedrooms -------- Number of baths ........ Lot size -�f .L�,F __.__---_-._•__•_ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table _i_._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No.Fr New Construction: Yes 9�`No ❑ FHA/VA: Yes ❑ No r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic mak: Distance from nearesf well_._____-___Distance from foundation__,f.0_____________-Material (,...•_...,•,•--------- ,p••• . + No. of com artments__ -- Liquid depth__..-�__ . p ty._.�"- P I - �----------f.._Size---- �b--�- - ---------Ca aci .Q_..,{.'.-- Disposal Field: Distance from nearest well--------Distance from foundation--/f-.r --_-•-___Distance to nearest lot line................. Number of lines_....'_�i-- _________ Length of each line------ _____..-.__.Width of trench------- Type of filter material__.-_ Depth of filter materiai___� ___- Totaenth------- g - _ r. . Seepage Pit: Distance to nearest well_____________ f3V .______,---•.,.,___._.. � C ________Distance from foundation___________________.Distance to nearest lot line------- S ❑ 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 1b ❑ Distance to nearestlot line-.- � Remodeling and/or repairing (describe) - -• -----�---------:........•-- •----• -------- 1 � --- - = - ------------ �-�yrr� � � •--�•l�'lJ � dY r�'`_--- 9.--- � -`—1 � � --- --------------- - I b certify that I have re ared this a licat" n and that th `�� Y Y prepared pP a wor rwtll a done in accordance with 'San Joaquin County ordinances, State laws, and rules and regulatlons of the San Joaquin Local Health District. (SI d �9ne ) r ._._�•1 � , 7r--------------(Owner and/or Contractor) By:--------------------------------------------------------------------------------- --------------------------------------------------(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---------- z Q ------------- DATE------. . REVIEWED BY_ � - -------�`�-� --------••--------------- - --•- --- � �-- ..--------•------ -----•--------------------------------- ----- - ------------------------._....--------------- DATE...--------------- ------------. BUILDINGPERMIT ISSUED-----------------------------------------------•--•----•-••---------------•------------------------- DATE.--------------•------------------•---------------------=- Al4erations and/or recommendations;. - ---------------•---••--------------------- - --- _.._....-------.....-----..... ._..._. -f --------- L-` -•• ••A••• -- ------------•-. ------- �2� �- -------- � ---�+r-----------� :� -,c-e-�... Y' ----------- - �.. .e t ,1 -------------------------------_-- ------------------------------------ ------ ------------- -. . � FINAL INSPECTION BY:.. ) Dater"""" -- -------------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California 13 9 REVISED S-S9 2M 8.61 ATLAS r . I