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lw FOR OFFICE USE: _ ------------------------------------------------------- .A -------------------------------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------- ------------ -------------- ------------------ (Complete in Duplicate) Date issued _____-7 /_7 G� ----------------------------=-------------------�---�--- ' This Permit Expires 1 Year From Date Issued / . .2 . 7•--/-M--/7 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 compli rice with County Ordinance No. 549. ��,�� LC/�l JOB ADDRESS AND LOCATION . rl" --- ------ fL A T--- ------------------------------------------------------------------- Phone------------------------ Owner's Name Address.--•---•-- a - -------- .? PhoneContractor's Name' ° V .t� t Installation . will serve: Residence [2-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _V_ Number of bedrooms .3. Number of baths _-/-/___ Lot size ._..- C. E ................ Water Supply: Public systemil/0 Community system ❑ Private V3--`6epth To Water Table,�_?ft. ' Character of soil to a depth of 3 feet: Sand Q'Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes ENo ❑ FHA/VA: Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: 4.4 `? ` -.'(Nb`septic tank-or cesspool per`rr5itted if public sewer is available within 200 feet.) �j Septic Tank: No} of nearest well-- ----- Distance from found __ ation ___.______-______-Material______..______.-_.__.._..._I......._____________- .- Tl'� E ' I -of , .camp a{rt ts - ----- �-----------------Liq did depth_-------------------------Capacity Disposal Field: Distance frorri nearest well---50---._Distance from foundation__._.1. --------Distance to nearest lot line..... t Number of lines------------ 6_i�--7-----Width of french.------2�/—-__r--------- C 1_____________________Lerigth of each line_______., Type�of-filter material...P�_CtS,___Depth of filter material_____ _._ Total length..___-._.fn0__--_______________ Seepage Pit: Distance to nearest well----------------------Distance from fou ndat.ion_....._.__n__. .__.Distance to nearest lot Iine..R.............. 1 I; ❑ Number of pits.-•-------------------Lining material------------ ,=:___-=Size: Di�am�ete .-----------------___-.,Depth-_----_-..._...-.. .......... Cesspool: Distance from nearesf�ell=�� r.._._. - Distance from foundation_?': -____ ___.Lining material...................... .............. I I. ❑ Size:. Diameter � ------------------Depth---------------------------------------------. -Liquid Capacity------------------- Privy: Distance fromt�est well_______________________________________ ^_- Distance from^ eares� building------------------------------------------- 0 ____..___________________ _..__..._. ❑ _ a g._ Distance to�neares+ lot line --------------------------- ---------- Remodeling and/oai-'r-ing describe)___________________ __________ k, -------------------------------------------------•--•-••------- ----------------------------------------------------------------------------••---------------•-----------•---•---•-----------------------•------------------- )----------------•--......_.. -- -------------------------------------------------------------- ----- ----------------------------------------------------------- .......---------------------------------------------------------f------- 14� -------------- -=---- ------------------------------------------------------------------------.......--------------------------------------------------------------...........................-------------- ............... d.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 regulatigns of the San Joaquin Local Health District. ) (Signed)---- ---------------------------------------------- (Owner and/or Contractor) 1 _. _ --•-•-. (Title) B ' - ------------------------------------ €-----:-- r_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i . i 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED _ DATE__ _ - --------------------------- REVIEWEDBY-------------------------------- --------------- ------------------------------------------------------------------------ DATE- -------- =.� . .... �.._.... �.r..^.. .� _ r• .. .. . . _. ..�. . _... . Alterations and/or recommendations-------------- .fi--------------••-----•--------.--- ' ------------_-.------- ----ti--------- -------------------- _.....___.I--------------------------------------------------------------------------------------------'----------------------------------- ----.-------------.... --• -------------------••-------------- ----------------------------------------------•-------- ----- ------ ------ ---- ----------------------------------------------------------------------------------------------------------------'----- I FINAL INSPEC : 2-- Da+e- - M`-------------------------------------------- �J SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 13.59 2M 5.62 ATLAS*'�