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r%-.Pm vrrrLc uae: -------------------------------------------------- _____ ----------------------------------- --------------- APPLICAttON FOR SANITATION PERMIT Permit No. ..///9�0__ -------- --------------------------------------------- (Complete in Duplicatel - - --------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ..... ..6�-- 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 md1h County Or inance No. 549. JOB ADDRESS AN OClTI N _ - �� Owner's Nam --- ----- --- ------------------------------- -- --•------------- Phone............................ Address----- . --- ------------- ---- ................-- -----•-----------------------•----------•------------------------- - .....................................e Contractor's Name............................ ----•----•----•----•---•---•--------- -------------------------------------------------------------•------ Phone.............................. Installation will serve: s Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ otel ❑ Other ❑ Number of living units: g I_____ Number of bedrooms ----L Number of baths ._._T Lot size ------ :-___________________________ Water Supply: Publici system ❑ Community system ❑ Private E. Depth to Water Table ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy jiLoam ❑ Clay Loam ❑-,Clay ❑ Adobe[ Hardpan ❑ Previous Application Made: Ilf yes,date____________________} No New Construction: Yes No [-] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ; (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i '�a ptic Tank: Distance from nearest well_________________Distance from foundation-------------------Material........................................ No. of compartments---- •--!---------------Size-----------.--------------------Liquid depth..--`--------------------Capacity------...._•--- .. Dpos Field Distance from nearest well-l-�I__._..._Distance from,foundati ,1.__.Distance to nearest lot line-- Number of lines_________ ____ Length of each line___ I' Width of trench----- .-_ -•- Type of filtet•,materiaLs-C� Depth of filter material-____ .........Total length____----._._�- Seepage Pit: Distance to nearest well__ ----------Distance from foundation-------------.------Distance to nearest lot line................. ❑ Number of pits----------------------Lining-material----------.------------Size: Diameter-----,________._____--.Depth------------------_•------------- Cesspool: Distance from nearest well_________________Distance from foundation s._.__--.._-......Lining material..................................... ❑ Size: Diameter------------ -------------------------Depth--------------A............--------------------.._Liquid Capacity-----------..-_----------gals. Privy: Distance from nearest well------------------------------------------- _____Distance from nearest building-------------------------------------- El Distance to nearest lot line Rema ling and/or re firing (describer e" J-•---•---•----------•-•-•-••-----------•- - -----------•---•---•--------( ---------•------------------•------------------- -----•-------------- ............ I hereby certify that I have prepare/ this application and-f-_h, the work will be done in accordan -_ ____--__ --••-___._-___ n - Y ice with San Joaquin County ordinances, State laws, and rules and re ulations f the San Joaquin Local Health District. + (Signed)--- -------------------------------------------------------------------.--.--•• -.(Owner and/or Contractor) E By:..............................___-------------------------------------------------------------------------•-------------------(Title)--------••--•-I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY........ --------------------------------------------- --------------------------•--------------- DATE---------- REVIEWEDBY-------------------------------------- •---- ---- ---- ---- -- ---------------------------------- DATE--------- ...�� " `'-• r BUILDING PERMIT 155UEQ.. - ----------------------_ ---------- DATE------------ - Alterations and/or recommendations:------------------ -- --- --------------------------•----- --- -------- ••---•------- --- ---- • --- ------------------------------ ------------------------------------------------------------------------------------------------ FINAL ----------------------------•--•--•-•---------------------------------------------------•---.._. FINAL INSPECTION BY:..---- . Date--------------_----- �� 5 ........ � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S►r*ot 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 RIMSEP B-59 2M D-61 ATLAS 1