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-------------------------------------------------- APPLICA� 4N FC)R SANITATION PERMIT Permit No- <br /> ------------•-------------- --------------------------- (Complete in Duplicate) Date Issued <br />---------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCA ION-- -------------------------------------------- <br /> Owner's <br /> ------------------------------------------Owner's Name. Cf _ ----- Phone.................................... <br /> Address-.----- -- • - <br /> --- - - - ..................................................... <br /> -- - -- - <br /> Contractor's Name------- - .._._.. .................. Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J-_- Number of bedrooms _,P- Number of baths __/__ Lot size ------­................... <br /> Water Supply: Public system ❑ Community system ❑ Private 2roo6epth to Water Table _4 994. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ _ <br /> Previous Application Made: (if yes,date--------------------) No 00' New Construction: Yes UR"No ❑ FHA/VA. Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sywer is available within 200 feet.) <br /> � a <br /> Septic Tank: Distance from nearest well--Aa _-Distance from foundation s'� ..•... <br /> 931-- No. of compartments_____.______________Sizeel�lP..,J�_,w_._•___Liquid depth___ ----.--_______Capacity._-.�.Q�._... <br /> Disposal Field: Distance from nearest well_.4 '--Distance from foundation__AQ__If-.-._.Distance to nearest lot line_.17.1_..... <br /> [ Number of lines_....._:_-____ Length of each line....!PAe1i` -------------Width of trench_A----------.-_-_-_-_-_.--- <br /> Type of filter material" _ _ _ epth of filter materlal__f ________.__Total Eength______ �________ __________•-_--_-- <br /> % 34 I <br /> Seepage Pit: Distance to nearest well-_���______Distance fr m fob�++ndation___�0........Distance to nearest lot line_________________ <br /> Number of pits....... --_-_-_-__-Lining material--�_l�----Size: Diameter-�V----_-.._-_ Depth_, 207,`.................. \ <br /> Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material..---..._--__--_-_-_-_-_-_--.-----.-- <br /> Size: Diameter--------------------- -De th--.----------_-------------------------- ----Liquid Capacity __gals. �s <br /> Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building------------------------------------------ U <br /> ❑ Distance to nearest lot line--------- ------------------------------------ ---=-----41 _1;.,.� <br /> --- -------------- <br /> -------------------------------------------------------- <br /> Remodeling and/or repairing (describe):-------- -1------------------------------------------ <br /> ----------------------------------------------------------------------------------------------------------------••........-•----------------------•----•--------•-•-------...-------.....--••-------------------.------- <br /> R ------------------------------•-------••---....-..-•-•-----._.....----------........---------------------------------.-.------------------•---•-•-----........---•-----•--•--------------•---•-------- •---------•- <br /> --------------•------------------•----•-•-•---•----•-------•--------------------------------•-------------------•--- ---------------------------------------•--•-----------.....-----...-----•-----••---------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> i <br /> {S�9ned}---------- - - --------- <br /> -------------------------- ---- --------------------- - ------'(4wclw Contractor <br /> By:............................................................ -----------------------------------(Title).__ f G/ ..---------------------- <br /> (Plot plan, showing size of lot, location of s m in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- ± ---,__-• Y, r-------- - ---•-- .- ---- <br /> ------------------------ DATE-- •, 1 --------- <br /> REVIEWED BY -------------------------------- DATE. <br /> BUILDING PERMIT ISSUED------------------------------------------------------ <br /> ----- <br /> --------------------------------------------------------------------------------- DATE.----------------------•••- <br /> AFFerations and/or recom endations:___-____ <br /> 3 -1 --.�.z_•--•--• � --- --------- <br /> y--- <br /> (�----- --- C1 — --._ ' <br /> 3...y- --..�..(o• ^>•"�� {,mss_(1�. '-------.�_ ... _.-.e-----------•-----------••-•-•----- --------------------------------- <br /> -------------------- <br /> -------------••------------ `vV <br /> c ` <br /> FINAL INSPECTION BY:.-3."------ ---- - •• ----•-••-•----------- Date----_-�`�-__--�-�-- t.•- ••---•--------•----------------------•--•---•------- <br /> J..; SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strew. 300 West Oak Stroh 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-89 2M 5-E1 ATLAS <br />