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----------------- ----- ------ rvrc Urrl�,t uat: ---- - ----- --- --------- -- ------------------------------ --- --------------------- APPLICATION FOR SANITATION , 4MIT (� Permit No. --------------------------- -------------------------_ (Complete in Duplicate) -------------------- --- This Permit Expires 1 Year From Date Issued Date Issued ....Vf Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance w' County Ordi-lance No. 549. JOB ADDRE S AND CATION ,` r � 1 -�`-_C-_.-------- Owner's me.•. ....... ....3------ -•-•--- --------- ---- - --- - ---- ----------------------------------- Phone................................... Address------- --- -----------------•- ¢ Contractor's Name--------------------------------------------------------- -----..------ -------------------__.................................. Phone....................... Installation will serve: Residence ❑ Apartment House ❑ Com ercial ❑ Trailer Court ❑ Motel ❑ Other t Number of living units: ........ Number of bedrooms _______: Number of baths ________ Lot size ____-_�� ....... Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ________ 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 ❑ New Construction: Yes ❑ No E3 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if up bUc se er is a it le within 200 feet.) �.�_t41 ,.�2'/� Septic► Tan Distance from nearest well__ "�� Istan from fou dation------1.e--=:---Materlai_- __-_... _1............. ' N of compartments 11 __)�- -..Liquid epth--------------------------Capacity. .�� p /... Size-- v +l Distance from nearest well ' "Didance from foundation_._T _____. aj1� to nearest lo/t/lir�e +� .` Number of lines..... _ __ ___-Length of each lin .^�F • �id?#1 of trench.-_ 4-- Type of filter material.__ . . _ _ ._ _ Depth of filter material____. . .�t__ Total length� �� ---- g 4?•X..,5"-=--.. _--------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------.-----------Distance to nearest lot line----------------- F1 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 Weil-------------------------------------------------Distance from nearest building-----------------------................... ❑ Distance to nearest lot line----�--`-/- ----------------•------------------------------•---•-------------.-------- Remocjeiin nd/o/�epairin (describe):__. et- E' ------- -----•--•-• -_---, - __?--------- , ..... .. ._�3-,�e��,__-.. _ ... .___!•__ - _. __ -A----------I-------------------•-••-----------------...__.-------- - --•--------•--- ...............___-1 -- ____________ __ ...-__ _______ _ -. ---------- _ _ _ _ r---------------------------•---- --------------•-----------....------------------•-•----------- I herebyY certify at I have prepared this applic Ion and that the work will be done in accordance with San Joaquin County I ordinances, Staterules. and regulations of the Sen Joaquin Local Health District. ws, and [ ' � .2{ (Signed).- =-------------•--------------•- -_-----------: - ..--------------------------------------------.._..----------------(Owner and/or Contractor) By:!... Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be, placed on reverse side). �. f FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE-----------•-•------------------------------ REVIEWEDBY------------------------------------------------------------------ -------- •--------------- DATE--------- = BUILDING PERMIT ISSUED ,------------- DATE. ._ AFte ions and/or recommendations:...... -- .............•----------------------•---------....----•----•-••---•------••-----•--------------•--••---------- -- --- - �. - --------...... ---- ---------- ----------............... --------- -� r-_... FINAL INSPECTION BY:.------ ---�., Date------------ ._._ '' -�----------- F SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak Sv►Nt 124 Sycamore Street 205 West 91h Strout Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 8-89 2M R-61 ATLAS