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FOR OFFICE USE: ------------------------------------- ----------- ------ ..........................._..___---. _ . _ . - -__._. APPLICATION FOR SANITATION PERMIT Permit No. .,/ .....1�..`� t ------------ -------------------------------------------- (Complete in Duplicate) -------- This Permit Expires 1 Year From Date Issued Date Issued ------------- Application _. /Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w rk herein described. This application,is made incompliance with County Ordinance No. 549. /Qce- Ins l �� JOB ADDRESS ANCA. N,�.s�1 - � .� Owner's Name ------------------- Address ---- Phone Address.._.----•---. .•-•Contractor's Name 2�- .._.....__ Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Kjotel ❑� Other ❑ U1 Number of living units: _, Number of bedroom ___ Number of baths/e- Lot size ____________________________ -5......... Water Supply: PubliC system'❑ Community system ❑ Private Depth To Wa er Table _�_.. ft. Character of soil for a depf- of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ley Loam ❑ ClayAdobe❑ Hardpan ❑ Previous Application Made: (If yes,date----------------___) No New Construction: Yes to ❑ El Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ DVVUb1] 1 t ` f Septic T Distance from nearest well--,5-10__-_Distant from foundation___/t'.._.___.__.Mat�ri _-.•. .._..-. No. of compartments Size ' 7P-- Liquid depth__..-/,- ----------Capacity...--- .. % � Disposal Id: Distance from nearest well.... ----Distan e o oundation... .� .....Distance to nearest lot [ Number of ' :} �/ Len�th"of each line._ �..__•�+�.._._ VVidth of trench---c�__1--------------------- Type of filter material....�1rf _YQ4�Wepth of filter material_/,f-!�---------Total length-----/_xO�-A-- Seepage Pit: Distance to nearest well----------------_-----Distance from foundation.............-------Distance to nearest lot line---------------- 11 Number of pits----------------------Lining material-----------------------Size: Diameter.---.------------------Depth----------------------------------. Cesspool: Distance from'.nearest well_________________Distance from foundation-------`............Lining ❑ t , materia l____.__-________-_-__-.-_______----_.Size:`;Diameter �-f---------------- ------ -------.De th------------------------------- ----------------_Li Liquid Capacity-..-------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building._._____---________-______-_---- Distance to nearest lot line ----------I--:r------••-----•--•-------------------------- t � t �f Remodeling and/or repairing (describe):-------------- -_ - --- -------------•--------•--------• ---------------------------------------------•---------••--------- -------------•-------------•-- ------•--- ;------------------•----------------... ------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Hea h District. (Signed) - r ---- - --- .�? . --------- ------[Owner I and/or Contr e - o auto - . -_-_- - - --- --- - -- ----------_•---==_-----.__._{iti (Plot plan, showing sizes}--•----• -- - , location of system in relation to we s, uildings, etc., can be placed on reverse side FOR DEPARTMENT USE ONLY # APPLICATION ACCEPTED BY--------- - L�� DATE �6F .................. REVIEWED BY ------- DATE BUILDING PERMIT ISSUED----------------------------------------- ----•-•--------------------------- --•----------------------- DATE------------------------------------ Alterations and/or r commendations: No _ .A f � -------� '��c► - 'R --------------- ----- ... - ---- ------ ----------- FINAL INSPECT ON BY:_. : -: - � Date.. ,/ ,,.. "".-l t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Srrest 124 Sycamore Stmt 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California 9 REVISED 8.59 2M 5-52 ATLAS