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FOR OFFICE USE/ -ov i, .._...... � - APPLICATION' F(?FI� Permit No. SANITATION PERMIT (Complete in Duplicate) Date Issued ..... • :-`� _ --------------------__ This Permit Expires 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 compliance4ith County Ordinance--No--544: -- JOB ADDRESS AND LO ATION_._____.��.-- �------ ---- - - �-- --�� - --------------------------------- k Owner's Name________ __ ._�_.��-- - -- - �- --- --•--- Phone...••---------------------------•-- Address. ....................--------------•-------------.--- --•---�•--- --------------- -- Contractor's Name-------- -..� -�-------•••---- - - •--- ---------••-------------------••-----------•--- Phone................................... Installation will serve: Residence'0/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .. L Number-of"bedrooms .Number of baths .. Lot size __._.. " . -----. --_-------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table - ft. Character of soil fo a depth of 3 feetF Sand ❑ Gravel C3 Sandy Loam ❑ Clay Loam ❑ Clay C] Adobe ardpan 4 ., __ Previous Application Made:; (lf yes,cl�aite__A------- ____) No 111-"New Construction: Yes o [IFHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { SAptic T Distance from nearest well -----.Distance from foundation.-�_Q___-.--,__.Material..__ i No. of compartments------N_- ------------- Liquid depth__._'y-- -------------- ...: ............ Disposal Fi d: Distance from near'e well,___--"-------Distance from-foundation__f --------- dthcofto nearest trencha I line_S�.-.--. Number of lines-----------------------------------Length of each lin' ----- of,filter material._.)t-'.° --------Depth -of#filter m ial_ ----------Total length-----------------••------•-------... ~ � { Seepage it: Distance to nearest well____--___-______Distance from foundation__ �_=:___._. �ce to nearest lot 01 lie___ ---------- See Lining material-- e _44---Size: Diameter--•--------------------.Depth._.. ------------•-••- --- Number of pits_.....e�_.______-- � , Cesspool: Distance from nearest well--------------___Distance from foundation-------------------- material__.________----__-----------•--FIs. ) ❑ Size: Diameter-----------0,__--------- --=-------Depth----------------------------------------------------Liquid Capacity.-------------------•----=-g Privy: Distance from nearest well-------------------------------------------------Distance from nearest building._____-..______.._______..-.----••--•__--- ❑ Distance to nearest lot line--------------------------------------------------------------•------•..._------='-.-------•"--- ;. .... + Remodelingand/or repairing __--__._ '____. __ --- -----•-- --•--- ••------------------ ------•----------------------•-------------•-------------•---•-----:---------------__-----------------•"----•--•------------------------------•----- - -------------- •---------------------•---_.----------------------:-- ---------------------------------------:------- I Hereby certify that I have prepared this application and that the work wil'r"hbe done in accordance with San Joaquin County ordinances, State laws, and ru and regulat' s of the San Joaquin Local Health District. (Signed)",-,",------ A. ----- ---- --- _____.(Owner and/or Contractor] By:--•••--••-•----••-••-•-----•--- --- ----•------- •- ------------ - -- ------- (Plot plan, showing size o , locati n of system in relation to wells, ngs, etc., can be placed on reverse side].. } FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED BY. i -------------------------------------------- ----------- DATE.. _-_1 ..�_. REVIEWEDBY. DATE----•.......__---_------••----•----------------•--------- Y' - _ � ------ BUILDING PERMIT ISSUED----_-----•-•-•--------._---------------------------- - DATE �-_� - ---------------------•-------------------•-•------ ------- ?=-z----�----••-------�� --_.__.�! _ c a�_In.._--------- ,f-�- AMeratians and/or recorrlmendations:_�_.__._ ••-. --------------------------------•--------------- F•--••-... - --- L -------------------------------------------------------------------------- G ----...."-- _f - i FINAL INSPECTION BY:.--. `-i� �` --------------------------- Date 5_.-__ _-..� -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California /"Fv,s ro 9-59 2M a'st ATLAS l ,