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d rUxUrf-ICE U5E: ff I APPLICATION FOR SANITATION PERMIT Permit No. ,1... ..�� — _.--------- (Complete in Duplicate) - ------• -.---- Expires This Permit i 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. F113, OSS'- 230 /-D JOB ADDRESS AND LOCA T10 c '" 9 Owner's Name..... a -- � JTQ- -- - -------------------------------------------- Phone.--------------•-.............. -•--- Address----- Contractor's Name---_. Phone................................... Installation will serve: Residence ❑ Apartment HOU OAE] .-commercial.❑{ a Ear'Court Motel ❑ Other ❑ Number of living units: -3'_ Number of bedrooms -----.__ Number of baths ________'Lot size --------------c��_ __• [h, -.-•-,-••--_-- , Water Supply: Public�systemw❑,orCI.ommunity�system Ej,,,erivate�jo- -Depth to Water_Table _____--- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑, sandy Loy m Gia Loam . .y ❑ Clay ❑ Adobe[] Hardpan ❑ Previous Application Made: (If yes,date---------- „1 No-,E] New Construction Yes ❑ No ❑ FHA/VA: Yes ❑ No ElTYPE OF INSTALLATION AND SPECIFICATIONS: �`�� '"''�---•--�' (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well____,-, jQ-..�-Distance from foundation `: - Material___-__Ct W No. of compartments------------ - --- -Size X�_EL�_X_S,.-_Liquid ...... - ...............Ca aci ,Z.4*�.4,G.-_•- Disposal Field: Distance from nearest well_____5a--.-Diss0iclk e'#'rom Foundation•.....: .,A- .Distance to nearest lot line.....-_-r._..�- lIF�+( Number of lines_-..__---___�.._____-___- Length of each�l e.__....�?00_p+, -.Width of trench.__..._�..r_....._ Type of filter material._._, Depth of filter material_------ To}al length____....._ZQQ_.�.____..._. Number of its...____ ��.{�. i Seepage Pit: Distance to nearest well------ from.itoundation_____ __________. ; Distance to nearest lot line._j_-5..__.. p L -----------Lining mataria�l.-/ 1 Sue: Diameter__.... � --- ----------•-,Depth-------v�-�`------------------ � Cesspool: Distance from nearest well_________________Distance from foundation....--------------- Lining material-____---__..___.______ ❑ Size: Diameter.-----i-------------------------------Depth----•----------------•-------- ------Liquid Capacity.......---------------------gals. Privy: Distance from nearest well__________________._______-____________.-.__._pistance from nearest building g--------------_------------------------ ❑ Distance to nearest lot line Remodeling (descril'e):------------------------------------------------------------------------------------- . 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)- ` � ._..__ - { dfrd/or Contractor) (Pl. . -_------=----------•---------..........{Title}--�-T:-------�-------- -----_ - ot plan, showing sire of lot, location of sys in relation to wells, buildings, etc., can be pieced on reverse side). - w.• . FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY - -- -- - - - -- - --------------- -- - ---------------- y -------••----------------- DATE-•- REVIEWEDBY_...-------•--------.•----------------- -------------- --- ------•---- •-- •--- DATE----------••---•---...-•--------•------------_--------- •------_--------- UI DING PERMIT ISSUED ------------------------••-------- -------------- DATE Alterationsand/or recommend'ations- .------------------------------------------- ----------------•--------•----------•-------•-----•----------------••-------•-----•-------•----•----••-•---..:.... ------•----•---•----- -------------- ----------------------------------------- -------------------------------------------------------------------------------------------------------- •------.--- FINAL INSPECTION BY:--- f --------------- Date--- d 6 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak Strout 124 Sycomort Strout 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVIBSo B•59 PM 8-61 ATLAS -