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FOROFFICE USE: ------------------------- ------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ..�. .. S_ (Complete in Duplicate) ----- ----- This Permit Expires 1 Year From Date Issued Date Issued --- Application is hereby made to the San Joaquin Local Health District for a permit f of onstruct and install th ork herein described. This application is made in compliance with County Ordinance No. 549. 6-dd I�1 JOB ADDRESS ALOCATI N... ... a _ a , Owner's Name---- ------ Phone.................................... Address.--•- Contractor's Name---- . . -- . ... ��✓.. r---•-- _---------_ ........ Phone..................................• Installation will serve: Residencie Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .'1.__- Number of bedrooms .-Z►_ Number f baths ___tLot size ----------!J�-_____r�__--C, A—________________ Wafer Supply: Public system ❑ Community system [3 ate PrivDepth To Water Table _ _____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Lid -lay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If 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.) Sank: Distance from nearest well------ Distance from foundation----- _6__ ____._.Material_________ ____I __ _._.. epti _............ No. of compartments--------'7.i------.----Size... SLiquid depth------ ___?-----------Capacity.../,A 4�_"_ Dispos Field: Distance from nearest well--- - ---�.-Distance from foundation......J-�..j_..-.Distance to nearest lot line.,............ P Number of lines--------(-____-___-______ -.-Length of each line__-___ r--------------Width of trench______ Type of filter material._-_ r-dZ.�k,..____Depth of filter material----11?-----___._.Total length_____,2_d___01________________________ Seepa Pit: Distance to nearest well ___-_a i.___-____Distance from f undation----/U_-+ ------Distance to nearest lot line____ Number of pits--------L___________Lining material___ 2__.Size: Diameter-------- Depth____--Z_.,S__{_______________ 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---------r------------------------------------------------------------- -----------------------------------------------------•--------------- Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------...................•--------------------------- ---------------------------------- ----------------------•----•---•------------------------------------------------------•-------------------------------------•-----------•-----_----............------------------------------------•-•-------•--•---------- } T - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S iptlaws, and ruVcafi gulatio of the S Joaquin Local Health D11W. (Signed) ---- {Owner end/or Contractor) BY= ----- ---------- --------- - - -- --------------------•-------- -- ---------(Title)---•--------------------------------------- --- -------------- (Plot plan, showing size of lot, f system in relei ion to wells, buildings, etc., can.be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- ------------------•--------------------------------------- DATE.... y'G_. .------------------------- REVIEWEDBY--------------------------------------------------- -------------------------------------------- DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED-----------------------------------------------------------.•----------------------------------------- DATE--------------------------I——----------•------------------- Alferationsand/or recommendations:------------------------------------------------------------------------------------------------------------------------------ -------------------------------- --------------------------------------------------- ---•-•-----------------.-------------------------•---------------------------------••-•--••-----------------------------------------------------•-----------•-------••-------•---•---------------•------------------------••-•------------------------------- -----•---------------------- --- -- ..---- FINAL INSPECTION BY-� ---.._- '� � L ---------------- Date ------------------------•----------------------- -------------------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 105 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i ES 9 REVISED a-59 2M S-62 ATLAS