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FOROFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------- --------------------------------------------------------- (Complete in Duplicate) Date Issued ___________________________ _ __ ______________________ 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 describ d. This application is made in compliance with County Ordinance No. 549. •ZQaQ L,.C,�.e ,�: � JOB ADDRESS AND LOCATION____, OfI --- .tall'/ ..""..... Owner's Name------ .--- Phone................................... Address.............fCT.t 4T____ ' Contractor's Name.................. Phone. ... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ s� � Number of living units: _f___ Number of bedrooms �.?--. Number of baths le--- Lot size _7if�' _. �` ............................. Water Supply: Public system ❑ Community system ❑ Private 9 pepth to Water Table .1494. Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lerdgan ❑ Previous Application Made: (If yes,date____________________} No [Bl- New Construction: Yes g?'"no ❑ FHA/VA. Yes g— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r� r / , SAptic Tank: Distance from nearest well----,I-�___Distance;rom foundation___11.0_._.._._.Material_..°L_ __�,�-f&.6.............. 91- No. of compartments_____,�•---------------size"--- ___ 8y_Liquid depth--_-!�Y---------------Capacity.. . Disposal Field: Distance from nearest well.._ `.*i_Distance from foundatiJo n___/47._......Distance to nearest lot line...�df�+...... 93-11 Number of lines.._.. ._._}} Length of each line____IA __.___.___ Width of trench...o�c.......................... Type of filter material.-F_._ p �-- ,_._. g � De th of filter material..., _____...-.Total length ....................... Seep Pit: Distance to nearest well___Distance from foundation....................Distarice to nearest lot line............. ._.- Number of pits----------------------Lining material-----------------------Size: Diameter----.------------------Depth---------------------•----------- Cesspool: Distance from nearest well__________ _•___._Distance from foundation--------------______Lining material._-________._-______________.____._._ Q ❑ Size: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------- -----------------------------_------Distance from nearest building.......................................... ❑ Distance to nearest lot line--------------------------------------------------------------- ....... Remodeling and/or repairing (describe):--------------- ---------------------------------- •---- ....... --------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ i-------------•------------------------------------•-•-----------------------•--------------------------'•----•---••-------•--------. -----•-•----------------- I hereby certify that 1 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. # Contractor (Signed) ---- 4 - - ------------------•--••-------...------------ ) Br•---•. ...------•.-•-••••-•---------------------------------------- ---------------------- [tris).. (Piot plan, showing size of lot, location of system i ation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ....... ---------------------------------------------------•---------------- DATE_...(o_-•Z_C'-'-<- --------- ------------------ REVIEWEDBY........---------------------------------------------------------------------------------------------------------------------- DATE---•-••---._...------------------------------------------- BUILDING -- - --------------------------------- BUILDINGPERMIT ISSUED...........................................----------------------...--........................I...... DATE-----------••-•------------------•--------------------------- Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------- v --------------------------------------------------------------------------------------------------------------------------------------------------------------- - -L -I—.....-------- - --------------------------------------------------------------------------------- "-ta_----._ . — -------------••------------------••- ----------- --- ----------------------------------------------------- o .. FINAL INSPECTION BY:.--- . s ------------------------------- Date - ---.--------------------------- SAN JOAQUIN LOCAL HEALTH DIS 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 9th Strout Stacktonr California Lodi,California Manteca,California Tracy,Coiifornia ES 9 REVISCo B-S9 2S1 5-61 ATLAS �J