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. FOR OF ICE USE- -------------- SE: { _ _._ �. �� ., APPLICATIONR SANITATION PERMIT Permit No. . C3 r/ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ..... Application is her 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' i*th County Ordinance No. 549. i � f JOB ADDRESS AND LOCATIO ......... --• I----------e------J-.{_[ _------- -, ,------•-- " ? Owner's Name.-- ...... -------••---------- -- --- --- --------•---------------------------- Phone................................ Address----- �-�-' .c :.+ .r...• - t ��" I Contractor's Name..-__s .� E;L11-t --------•-•-------------------------------------------------------------------------------- Phone.................................. t Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ©� Number of living units: ........ Number of bedrooms:____%;Number of baths ........ Lot size ---.---.--I—----- —sem__...-..... y Water Supply: Public system [-] Community system El .Rrivate �epth to Water Table ti?7 ft. Character of soil to a depth of 3 feet: Sand-C]_ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&3""Hardpan ❑ Previous Application Made: {If yes,date------:"T:_----- No New Construction: Yes 9- o ❑ FHA/VA: Yes ❑ l`'.�o.C� , TYPE OF INSTALLATION AND SPECIFICATIONS , (No septic tank or cesspool permitted if pubPic`sewer is available within'200 feet.) Septic Tank: Distance from nearest well::f001-Distance from foundation---,�__�......_--.Material_--- !!l2-[_:._- ;. ..... No. of compartments ! � rin 1P 2 Size =$ Llqurd depth Capacity-•-5�Q0- _ i Disposal Field: Distance from nearest well__110_"`Distance from foundation....-Z-..- Distance to nearest lot line Number of lines-__-------- Length of each line--------- - - ---------Width of trench.__-.- ,-- _---�---_...._--..- J l g r Type of filter material._._.R- --- fC Depth of filter material-------L_4-------.__Total length----_-..-_-4-�.-------------------- 1 Seepage Pit: Distance to nearest well----------------------Distance from foundation................... to nearest lot line...••------.----_ ❑ Number of pits----------------------Lining material....-------------------Size: Diameter----_..._..----------_--Depth................................. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material....................................... ❑ Size: Diameter----------- -----------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Q1 Privy: Distance from nearest well--------------------__-----._-_-----.._- Distance from nearest building-----------_-----__------------_----.----. y ❑ Distance to nearest lot line--------------------_----•-----------------------•--------------....-.-----••---------------•---------•-------------- 1 },, I kemodeiing and/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).__, ------------------------------ JOwner and/or Contractor) By:.................. !•---F------:,...`-` `-------------•----................•---_---- (Title)--•----------=----------------------------------- ------------•- ' (Plot plan, showing size of lot, locetion of system in relation to wells, buildings, etc., can be placed on reverse side). i _ 4 FOR DEPARTMENT USE ONLY �` APPLICATION ACCEPTED BY------r- ----------- ------------------------------------------ DATE-----3 Y._(,z ` G-_72------------- ------ REVIEWEDBY--------------------------------------------- - DATE-------•-----------------------........ ��. _ _ - BUILDING PERMIT'ISSUED. " == = = -�- ATE.----- -- Alteratio s and/or re o dations:- - ��e�.a _ - 1 .r -=--- -- -rl- =-�- � • - --- '- ,� --•-----------•••------------- -----------------------------•-----------•--.------ �_ FINAL INSPECTION BY:.- f300 �---------------- Date --------------------------------------------- - Y JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street st Oak Sneet 144 Sycamore Street 405 West 91h Street Stockton,California Lodi,California 4\ Manteca,California Tracy,California E6 9 REVISED 8-99 PM 5-6[ ATLAS "�.'.+as'=