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FOR OFFICE USE: r . APPLICATION FOR SANITATION PERMIT Permit No- ------------------------ (Complete in Duplicate) tG"Q L_ Date Issued ---•r-- -•--.......... ----------------- ------------------- This Permit ExEires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instaA the work herein described. This application is made in compliance with County Ordinance No. 549. ,� JOB ADDRESS DLO ATION. d�Q..._ �- � ------------- 6 Owner's Name ` '.. ---- ------------- Phone I Address--------------•--------••--- ;............-- Contractor's Name--- - ------------------•-------- Phone------_-----------_-------- Installation will serve: Residence &-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ . Number of living units: .-- Number of bedrooms __ _. Number of baths AL Lot size -___ ' "prX__. _____•-•••-••-----••-- Water Supply: Public system'�Community system L] Private ❑ Depth to Water Tabled ft. Character of soil to a depth of 3 feet: Sand ❑ ' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[j-11ardpan ❑ Previous Application Made: (If yes,date--------------------I No New Construction: Yes []rNo ❑ FHA/VA: Yes ❑ No 2�- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept'T nk: Distance from nearest wellttl r`[_.-Distance .r m found t' n..1Q_...._......Material..................................:.............. No. of compartments------ 2-------------Sizi ----------Size-•--._.. ---- ---../1�}Liquid depth- -------------Capacity....f 1 .. Disposal Field: Distance from nearest welJ/ks ..Distance from foundetion.149............Distance to nearest lot line.-..16........ ❑f Number of lines-------- - ---------- --------Length of each line-_- ------- -------------- of french-------6�.-�------:--------- � Type of filter material_` ._--_--Depth of filter material_.Jr_ ----------Total length---------- ....... Seepage t: Distance to nearest distance m f atin. .�-__-...Distance to nearest lot line...vJ.-.-.40A---. ----------4,4-1........G Number of ------Lining material--- Size: Diameter----33----- Depth - , ' Cesspool: Distance from nearest well____-------------Distance from foundation--------------------Lining material______--__--________------._____-_--- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------•-•---_-------gals. Privy: Distance from nearest well----------- ______Distance from nearest building______.--_---__-____......-_ ------------ k ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- € Remodeling and/or repairing (describe):-------------------------- •-------•--------_----------.---...----•---....----------------------------.............................................. _., I + I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. F•, (Signed) -----------------•--------------- --- ---------- ------------- --------------------- -----------------------------------------------------(Owner and/or Contractor) By:................................ --- ------ - --------------------------------------------- ------- -------(Title)------------------------------------------------ --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEA MENT USE ONLY f APPLICATION ACCEPTED BY -----------------------••--------------- DATE.. r `�. .. IREVIEWED BY--------------------------------------------- ------ •- ----------- --------------- -----------------•--------------------- DATE----------------- -------_--••-------------------- BUILDINGPERMIT ISSUED------•-••-• •--------------------•-------------------•----------------------------••-------------- DA-TE-----------------------------------.------._...------------- Iterationsand/or recommendations:----------- ------------------------------------------- -----------------------------------------------------------•--•---•--•-•---------------------------- . .............. -� � . :. ----------------------------- ------------------------------._ FINAL INSPECTION BY:. ---- Date----- — ✓--r .... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore S"ti 205 West 9th Street Stockton,California Lodi,California Manteca,California Yracy,California ES 9 Reviseo 6-99 2Mi 6-61 ATLAS 4 t