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FOR OFFICE-USF- 6& FFIE.USS ------,�C_--_------ Y--/. 3 _-- :..--.------ APPLICATION FOR-SANITATION PERMIT Permit No. . . ------- --- ------ --•------ --- -------- --------------- (Complete in Duplicate) Dto Issued -------- Expires --...----------------- ---------------------------- This,Permit 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,coropliance.with County Ordinance N� I��._ "—" `r JOB ADDRESS A LOCATION. -• ... ` 7`� --------------------• Owner's Name-- -- --------------------- ]] /J , - Address-....... - - -- -~--- �f --- ---- Contractor's Name------------------------- -- -0 --- Phone_. - _O�A! T Installation will serve: Residence•• Apartment fHouse E] Commercial E] Trailer Court ElMotel ❑ Other ❑ Number of living units: /.-...•. Number ofibedroomsJ_-. Number of baths`Z.1ot size -----------------7.Q-----__._- _-_... Water Supply: Public system ❑ Community system ❑ Private K Depth To Water Table/_!< ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam);( Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------------------.-) No ❑ New Construction: Yes ❑ No 2L FHA/VA: Yes ❑ No Rr TYPE OF INSTALLATION AND SPECIFICATIONS: ( o septic tank or cesspool permitted if public sewer is available within 200 feet.) +' Distance from nearest well-----------------Distance from foundation--------------------Material_-.-----.---_--..--.-_-__--------::-.-.---_-_--_. No. of compartments---- ----.-Size--------------------------------Liquid depth_-------------------------Capacity---...:.---.- Disposal Field: Distance from nearest well-- -------.Distance from foundation.4-0---------Distance to nearest lot lines........ ' Number of lines........./----------. Length of each line....- 4----------------Width of trench---.--�-5�__------- r, Type of filter material...5!_�jf -Depth of filter material----_/$f----_-.Total length------------------...----�._........ tE Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---_----.---_---_ ,fes ❑ Number of pits----------------------Lining material-----_------------------Size: Diameter--------------.---------Depth---------------------.-.__------. Cesspool: Distance from nearest weil-----------------Distance from foundation--------------------Lining material--.-------.._--------_----_---__.-.-- ❑ Size: Diameter--------------=-----------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest,well-------------------------------------------------Distance from nearest building.--_----_-_------:v_-_---._--------.----. [] Distance to nearest lot line---------------------_-- J - 1 Remodeling and/or repairing (describe)---------------------------------------- ................•-•----........................J.................................•---- -----••-- r, --------•-------•--------------- •-- ------•- -------------------------------- _-----------------------•--••--••-----------_--__---_-_-•--•---_-___--_•---__----••__-----___•_------------....--------------------------------------------------------------------------------------------------------------- 1 hereby ertify that I have prepared this application and that the work will be done in'accordance with San Joaquin County ordinances, + e laws,wand ales and egulations of the San Joaquin Lpcal Health District. (Signed)-• ------- ------- -- -- ----D�o -- -- - ------------------ ---- --------------------.-. wrier and/or Contractor) B : ---------------------------------------------- .--------- --- -- ..-..-------(Title---- - - ------------------------------------------ y ( } (Plot plan, showing size of lot, location of system in relatiwells, b ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -- --••---------- DATE ---------- --------- REVIEWED BY-------- .-. ` � DATE--- -------------------------------------------- ------------- ------------------------------------------------------- BUILDING PERMIT ISSUED - --------- - --------------- -- D'ATE------=-----------------....-------------------------------- --------... Alterations and/or recommendations:--------------------------------------------- ' --...----------------------------------•---•----------------------------------------------------•-------....----•--------------=--------------------.......----••-----•----•-------------•-•-----------•--•--.--... ............................... --------------------•------------------------------------------..-..------------------------------------------------------------------------------------.-._...---•----------- FINAL INSPECTION BY:--," -...--- --- ----------------- Date------------------ i - -------------------------------- SAN JOAQUIN LOCAL HEALTH.DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Strut 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISEo a-S5 2M 5-62 ATLAS r