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VUK UNIU USE: --------------•------------••-------------• ------------- ______________________________________________._____---- APPLICATION FOR SANITATION PERMIT Permit No. __1...... 1� ----------------- -------------------------------------- (Complete in Duplicate) --------------- This Permit Expires l 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. V` l JOB ADDRESS ANLOCATION . -----• - -- ---, , ----... rl'v`..�,1. ,l------ l Owner's Name..._ ------------•------•---------------------------------- ------••------------------ Phone------------------------------------ Address _e ��Z v ' 'l� ;rQ ------------- - ------------------•--------------•-----•-----------------•------------------..--------------- Contractor's Name - ------------------••------•----------------------------------•------I_'-----_--_--------•------- Phone................................... Installation will serve: Residence Eq Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A_'-- Number of bedrooms _3_. Number of baths _)_a._ Lot size -__ p _________________ Water Supply: Public system ❑ Community system ❑ Private W Depth to Water Table 16�ft. Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam O] Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date---------------__ __) No jj� 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.] Y SP tic Tank: Distance from nearest well.... .....DistaInrc ? from foundation----I d ..................... No. of compartments-----_ •-------------- -Size_ .Liquid depth--------4/..............Capaeity..f.;,_- ------ Disposal Field: Distance from nearest well-- 'p----_-__Distance from foundation..4-Q...._..___.Distance to nearest lot line... C9Number of lines-------..;Iti____ ____p_ _____ Length of each line-----/-1?----------------- of trench.___�_�_-------- --------------- Type of filter materia ak_+tLG __Depth of filter material-----le-"--------Total length..---_`_ire_072I---_--------______........ Seepage Pit: Distance to nearest well____1—-------Distance from oundation__ 4'__._._....Distance to nearest lot iine__n............ 04 Number of pits.--;2- Lining material.0 ----------Size: Diameter-----31. ........Depth__,-_r..................... Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material.......___.__________---_-------___- ❑ Size: Diameter--------------------------------------Depth-------•-----------------------•---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------- ____._Distance from nearest building----------------------------------.--_-_-. ❑ Distance to nearest lot line------------------------------------------------- Remodeiingand/or repairing (describe):-----------------------------------------------------------------------------------..................................................................... ...............................------------••-••-•----•-----------------------•----........--•----------------------------------------------- -•---------•---------•---------------•-----•------------•--------------------- --------------------------•---------------------------....----••------------••----------••--------•-------•---------. ..............------------------------------------................................................... ------------------------------------I——-------------- ----------•-•-----------_----------------._---------------- --------- 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 Health District. (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). * FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-11,P160--- ....... ------------- ---•---••------------------------------ DATE ?/ REVIEWEDBY------------------•----------•------------------------------------------------ •------•--------------------•----------- DATE BUILDING PERMIT ISSUED-- ---- ------ -----_ DATE-------------- ---•---- A�n reps rn ' -------- --- ------------0._' ------3--------------------------------------------- �'-` ------------------------------------------- - ---------------------------------------•-- ------ ----------------------------------------------------------•--•-------------------------------------------------•-------------- FINAL INSPECTION BY- ----- - --- -- - - ---------------- Date--.6� �._(Q_3 ._ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Strut 144 Sycamore Street 405 West 9th Strut Stockton,California Lodlr California Manteca,California Tracy,California EB 9 REVISED &-89 2M 8-61 ATLAB