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-------------------`--------------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. ...,[.3_1C1..A- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued ...J,/ / ------------------------------ ----- ---- ---------------- Date Issued - Application is hereby made to the San Joaquin Local Health District fora 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._.._ .I__VC—_ " Owner's Name__-. ' � �. � �Address _ � t- Contractor's Name______, _ ------------------------------------ Phone -� Phone---•-- .................................. Installation-will serve: "Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Moe Other ❑ Number of living: units: __ _ q �". Number of bedrooms __-_____ NumVDe'j aths _/___ Lot size ___.___.. .__ .,J�-�•.�� Water Supply: Public system ❑ Community system ❑ Private Water Table ---____. ft. Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam Loam Cle❑ y ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No'❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank`:; Distance from nearest wail_________________Distance from foundation-------------------Material___.-______-___._NOffo. of compartments ._..___._-_..........._-_•...... Liquid depth--------------------------Capacity ----•------------------ Disposal Field: Distance from nearest-well-_1 *:'Distance from foundation----to.......Distance to nearest lot in E!r— Number of lines_ . ___j -____ f- ._' Length of each line_.._��Q______r"_ Width of trench..... / _ ' �_1TYPe of filter materiaL $ _.Depth;of filter materal..__jg"----"."""-Total length--------------------__".". Seepage Pit: Distance to nearest well__,.1___�._____._____Distence from foundation....................Distance to nearest lot line----------------- ❑ Number of pits - -- --------:Lining material---------------------Size: Dian�ter '= -Depth t „� Cesspool: Distance from nearest well_________________Di3tance from foundation___._.--------------Lining material..______..__-____.....____---____.--- ❑ �^Size.Diameter_ Depth------------- ---------------------------------------Liquid Capacity---------- gals. Priv ` " x , Privy: k Distance from nearest wE II _:" _ _ ________---__...__Distance-from'nearest-building_-_______-._____-_---___- -� --•------------- ..�❑ Distance to nearest lot line_....:: — = -----------4-------------------•--•-----------•--•-•-----------------------•------••--------f--------------•-------- Remodeling and/or repairing (des cr'be):1____________________- I --------- - •-•-•--••-•--•----------------_ D.D__1_TI"o_--- -------- o-------F�Ct T!_-A -.16 I_ ,4,L� ..__C *! -M----7b----SL�g -IQ-----��K I-Q�.t�t��'7[�_. �L ��A �... F A ------------- r ------------------------------------------•---- ---------------------------------- i I hereby certify that I have.,prepared this application and that the work will be-done in accordance with San J4quin County ordinances, Stat I s nd rules and regulations of the San Joaquin Local'Heaith District. ' (Signed) ___--.t._. ..:..:.......Owner and/or Contractor B - (Title)--'`� ----------------------_--------------y -------------- ••------------•-----'•------------------------------- p (Plot plan, showing size of lot, location of system in relation to wells buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY •_ APPLICATION ACCEPTED BY ---------------------"-------•--------- -----•-------- DATE----- l A f REVIEWED BY----------------------- -- t i -- ----------------------------------------------------...--- ----•••------- DATE....--•-------••--------�----�'�------- BUILDING PERMIT ISSUED_,_..._.---------------_--------------------------------------•--------------------------------------- DATE_ Alterations and/or recommend'ations---------------.._. F 1 -------- •----"-- ---•---------------- -••---•--- - --•----•------------------------------------ ------------------------------------------------------------------------------------------------- ------------•----------•--------..--------------•------------------------------•----. " ----------------- -------------.-------------•...... FINAL—INSPEC - ----- �..;�. ----`1`- --_.._. I'tn SAN JOAQUIN LOCAL HEALTH DISTRICT 0 1 130 South American Street 300 West Oak Street 124 Sycamor*nStreef 203 West 9th Street Stockton,California ' Lodi,California Manteca,California Tracy,California ES 9 REVISED 8•99 2M 5-61 ATLAS y