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VUKUrf (_h USE: ------------ --- ----------------{ r .(Jf—"-1---F. _� _f__--- --- U APPLICATION FC}R SANITATION PERMIT Permit No. 14 ,k -- ---r ------- --- ----------- ---- -•---- r (Complete in Duplicate) c [r --- --- ---------------------------------•------�--- This Permit Expires i Year From Date Issued Date Issued _�..Z'_� _( 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 compliance with County Ordinance No. 549. 4 JOB ADDRESS 'AND LOCATION_1 L _ __._.- _ Owner's Nanie - atir-------------------- -----------•-•------- Phone------••-------•-------•------------ Address r Contractor's Name.............................. Phone................................... Installation will serve: Residence ` iApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1__ Number of bedrooms _3__ Number of baths .1-___- Lot size _. _. �............................. ,Water Supply: Public system Ejg, Community system ❑ Private 0 Depth to Water Table _�p ft. Character of soil to a depth of 3 feet.= Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2-- Hardpan ❑ Previous Application Made: (If yes,dote-------------------- No New Construction: Yes ❑ — [�No ❑ FHA/VA: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi T6n Distance from nea}rest well_________________Distance from foundation-___...____________-Material-_____________----.-.._.____----_-_---._-__-__--- No. of compartments--------------------------Size----------------------.---------Liquid depth-------------------•------Ca aCi Disp I Distance from nearest well.._Distance from foundation.f�________._ Distance to nearest lot line.-`.-_.... Number of lines_______-_1-___________________ Length of each line------_-��_.®_ ________-__-..Width of trench---------- ,i!�'___________-- � Type of filter material.T��,--_________Depth of filter material____ *"--------Total length_--____3_v___________________________ t ( r! Seepage Pit: Distance to nearest well-/ ___Distance from fou dation....!��__--___-Distancg�to nearest lot line-�,1`-........... [+ Number of pits--- ------------Lining material__ .. .. pth--------•.---•''�•- Size: Diameter_._... De ____..__ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-___---____-__________-----..__.____ El Size. Diameter------------------------------------._Depth----------------------------------------------------Liquid Capacity.............................gals. Privy: Distance from nearest well__._____________________ building*------------------------------------------ from nearest buildin __________-------_.-__________________._. 171Distance to nearest lot line------------ ------------------------------------------•-------- f Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------- ----------------------------------------------- ------•----------------------------- --------------------•-----------------•------------••--------•---------------------•--------•-•---------------•--•-•----•-----------•------•-------------•-------------------•-•- --- 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 re2ofsysfem ulations of the San Joaquin Local Health District. to (Signed).............. --------------------41oation ------•----•--------------------------------------•-•--------•---•-•--------- ------(Owner and/or Contractor) By:....................... ------ ---•---------• --------------------------------------------------------(Title)------------------ --•-•-------•----•------- ------------------- (Plot plan, showing size oin relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-jr.-- ----------------------- ----------- DATE__L __"- �f---- --L-------•--------•------ REVIEWEDBY.... .-----•-•---------------------------------- -------- ---------------------------- DATE = BUILDING PERMIT ISSUED--------------_-- .......---------------------------------------------------------------------------- DATE - Alterations and/or recommends Ions--=-______--_._._ .__s_..- ,. ------------------------ --------------•----------- cam►.- ........ FINAL INSPECTION BY:-- '- - ------- ----------------------• ` . Date--- �-- V..`--:�-•L-----------------------•- • • - Ilk SAN JOAQUIN LOCACHEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 sycamore Street 205 West 9th Street r� Stockton,California Lodi,California Manteca,California Tracy,California 't S'! OEV46Eo 6-99 2M 8.31 ATLAS