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FOR OFFICE SE: _ 1'1 ----- -'---- �; -------------- ------ --- ..___---_..__.__-_-. APPLICATION FOR SANITATION PERMIT` ;,_- Permit No. ..... 1`�.�. ------------------------`------------------------------- (Complete in Duplicate) ly �/ Date Issued __ f. --- This Permit Expires 1 Year From 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. -JOB ADDRESS AND LOC TION----=�'-/. - ....... --------------------------------------•----•-------------------------------- ------- r Owner's ------------------- ------------- - --------------------- Ph "A Address.-•----4-57--a-Z------ Contractor's Name....Afx -•---•------------------------------------------- Phone-- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. ..-I.. Number of bedrooms __ Number of baths ___I____ Lot size ._s Q_ _ __` --------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ i Previous Application Made: (If yes,date----. --------------) No ❑ New Construction: Yes B-IN, ❑ FHA/VA: Yes ❑ No 0� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well, ..Distance from foundation---I Q--•-------Material--- ...................... ® No. of compartments.. ---------------Size_..j_..XZ0-----_kS'..__.Liquid depth_._._ -______._____Capacity ?0 Disposal Field: Distance from nearest well- -- --- ---Distance from foundation...t..7__4.......Distance to nearest lot line..:. ..1....... Number of lines_______ _-----------------------Length _th of each line--- �'---------------.Width of trench ____ _Ile ------------------ Type of filter material._R,t_C?J'`J-------Depth of filter materia_ _./_ -------Total length..___$01_-'_•_____________________ Seepage Pit: Distance to nearest well----------------------Distance ,from foN,� ----------Distance to nearAst lot line................. ' ❑ Number of pits______________________Lining ate _�._ .____ -S. Iameter__-_--- ----------------.Depth--------------------------------- Cesspool: Distance from nearest well _.__ ist foundatio -------&•rlldrg material..................................... ❑ Size: Diam r-- ---- -- "---- - �th.- --- ------- iquid Capacity----------------------------gals. Privy: �QIs ' mr n ------ Lut.—_ nce fr building --- ----••---•-------------------- .U'�s a rest l ine ------- ---------- 4 .----------- ----------------- or re scri G �/ • °� . -----------------------------------------------•-•-------••---------....._-....------------------- ----- ------- - -`-•---- ---- --------------------------------------------------------•---••-------•------------------•----------- ------------------------- e -. --- -----------e certif a is application and that +he work will be done in accordance with San Joaquin County or in n5pC aws, and and regu ations of the San Joaquin Local Health District. r 1 igned]-----t--�� J-•- .... ........... ---- j (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-jt ------ --------_-_ DATE---C-- - --•`- .- ---------------------- - i - -- -- --- ------------------------------------------- REVIEWED BY - --- DATE BUILDINGPERMIT ISSUED---------------- ----------------------------------------------------------------- -------------- DATE------•-----....-----------------•--------------------------- I Alterations and/or recomme dations:-- *!n�� i' --! ... :_ �� _ ___ �"'`-:•-- •; (,L ` �------•-- - ----• - --- . . ----- ....... . ..........• .....-- `' --•-•---- ----- - ---------- = =f - ....... FINAL INSPECTION BY-------------4 ~K- .------------------------- Date------- uf. t SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Stro.l - 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California M anteca,California n jjTracy,Cafllff/o�is W9RISE e- 9 2M 5-61 ATLAS ,,,/ .// �!�� j / y� �r�