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rVKVrrlt..t UJt: -. ----------------------- ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....C. .., ��5 --- --------------------------------- (Complete in Duplicate) S ------------------------------- 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 AND OCATI -1-.---. _"� _ --.- .... Owner'sName-...... -- - --------------------------------•--- -------------------------------------------- Phone................................... Address...................... ---•---------------- Contractor's Name.. .-.. `. -..._> ----. .................... Phone.. - Installation will serve: Residence [T-'-A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units:./... Number of bedrooms . .. Number of baths ./-. Lot size ..z7?,A9_ __..- Water Supply; Public system' [3Community system ElPrivate 2--6eipth to Water Ta�-ft'Ip I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ !Sandy Loam Ertlay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction:,Yes ❑ No Rj-"FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: f koNseptic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well---_-------_--.-Distance from foundation.-------------------Material---------------.-..................... .......... . No. of compartments-- ------------------...Size.__--------------------------Liquid depth-_---------------------._Capacity-•--••-----•--•...••-- Disposal Id. Distance from nearest well-S-0---- Distance from foundation--3.Q-4 -Distance to nearest lot line_��....-.... Number of lines------- __.. Len th of each line---- - g > ._._. Width of trench---- .. Type of filter material..._.l --_ p "T S' - ---.._ ._.De th of filter matenal___�- --__-_--Total.length-----------------10---•----.-.._-_.-- I Seepage Pit: Distance to nearest well-------------------_.Distance from foundation....................Distance to nearest lot line._----------_-_ ❑ Number of pits---------_----------Lining material-----------------------Size: Diameter.---__-__-__--a....._.Depth------------------------------- Cesspool- Distance from nearest well-----------------Distance from foundation-----'- -----Lining.material..-.---_----------_--_--------------. ❑ Size: Diameter---------------------- -- -------Depth----------------------------------------------------Liquid!CaacitY-. i...-•-•------•--••-.-9als. Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line-------------------•-------------------------------••--•-- ' till Remodelingand/or repairing'(describe)----------------•----------------------------------..--------------------------------------------I------------------------------------------------------ ---------------------------------------------------::---------------------------------- --•--------••--•-----•-----•---•-•---------•---------•---------•------------------------------------ ---------------------------------------••----------------------------------------------•----•-•----------.-------------------- ----------•------•------------------------------------- -----•------------••-•-----------------------------------•-••--•-----------------------------------.-.---------------------••----•--------------------..-...- ,. --------------------------------------------------------- ------------------------------ ------.--- -------------------------------------------------------------------•-------•------ ----------------••---•----- I hereby c 'fy tha+ I have pre d this application and that the work will be done in accordance with San Joaquin County ordinances; St a s, rules d gulatipns f the 5a ,o�aqu/in Local Health District. {Si nedt K-- /--------r---- - ---�"--' •--- -------------------------- n q )----.--- -_. rear and/or Contractor) - - - - _ --.---- _ (Plot plan, showing size of lot, location of system in rely ' to we s, buildings, a+c., can be placed n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -------------------------------------------------•---------------- DATE------ -2j REVIEWEDBY----------------------------------------------------------------------•------------•--------- `--------------------------- DATE----------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------•------------- I-----------------•-_---. DATE--------------------------------- Alterations and/or recommendations:--------------------- ------------------------------------------------------------------------------------------------ -------------•---•------------•---------•--- •-------• ----------------------•-•------------------------•-------.--.----------•--.-.-....------•-------....----....----------------------------------_.•---..••---.... ........... -----------•--•-------•---------------------------------- ---- -------- ----------r�. -..............."--------------•----------------------------------------------- ----------------------------- .........................•-------..............----- --- ----•------------- ----- --- ----------- ---------•---•----------------------••---•- -------------------•----------- - ay FINAL INSPEC _._ �r Zoo Date-------------------- - SAN JOAQUIN LOCAL HEAL 130 South American Street 300 West Oak Street 124.Sycomore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9 9 REVISED 8-99 2M 9-61 ATLAS