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rvr,vrrlt,c uac ------•---- APPLICATION FOR SANITATION PERMIT Permit No. __1.................. � --------------------------------"---- ------------------ (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 compliance with County Ordinance No. 549. - JOB ADDRESS AND LOCATION------- -----------!1.� ` = . ..•-4.4 ----- ------------------_----•-- -------------------------------- Owner's Name.......... .......... - -----•---------- = Phone.................................... Address--------- ...... ---- -- �..�'+tom «�� r-'.__ Contractor's Name...... ------•--------------------------------------------------------- -------------------------------------------- Phone_................................. Installation will serve: Residence 53 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: _ ----- Number of bedrooms .._3__ Number of baths .�-��/ Lot size ...... _ J.............................. Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table S.' ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 2} Clay ❑' Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------1 No X New Construction: Yes 1� 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 well....trP -Distan,cAef/rom foundation__._-�--_---...M erial----_-_.................. .................... No. of compartments-----1------- .----Size..T1y _ - . ._.Liquid depth._- --------------------Capacity.-/,�-.A�.--_. Dispose) Field; Distance from nearest well-4-- -------Distance from foundati __ld�___..._.Dlstance to nearest lot line........... rVf Number of lines.____.-. l Length of each line____ I---------_-----Width of trench--_, -------------------- Type Type of filter materi _ --,7jk-4 Depth of filter material_._Zr?:!---------Total length--- ----------------- ........ See�ge Pit: Distance to nearest we &V'._ ...Distance r�o��m//f�oundation.../#".......Distance to nearest lot line_...__.__ Number of pits_.,�---------------- material_ ,KW.--------Size: Diameter_._._33--------...Depth-- �..-.---.._-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material...-.---__---_-•---------__---_------ El Size: Diameter------ -•----------------------- .----Depth.-•------------------------•------------------------Liquid Capacity-------------_-•-•-•---•--gals. Privy: Distance from nearest well---_---------------------------------------------Distance from nearest building.............................................. ❑ Distance to nearest lot line---------------------------------------------__------------------------------------------------------------------- -\.% Remodelingand/or repairing (describe)-------------- ••------------•------------------------------------------------------------------ ........................---•---------••------•-•-•----- --------- ---------------------------------------------------I-----------------------------------•---------••--••-----------------------------I——------ ---------------------...-----•----------------•--•--------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances tate laws–and rules and regulations of the San Joaquin Local Health District. (Signed} ......... •• --------------------- --------------------------.._.----------------------------------(Owner and/or Contractor gY� ..... _ —_ - =_-(Title):------------------------------------------ (Plot - ' ...........-•------•-------------------------------- plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-. -- - - - - - - ------ _------•- DATE l �' ---------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE BUILDINGPERMIT ISSUED............--------------------------------------•---•----------------------------------------------- DATE.-------------------..-... Alterations and/or recommendations:---------------- ---------------------------------------------------------••--•-----i----•-------_•-�-_---------•------- ----- ------------- -- ..........-- ----•-.----•----- ........ . - - .... _ � .... ---------------..--.--.---------- -------------- -------- ------------ _- ----- ----- ............... -- -- ....... FINAL INSPECTION BY------------------- •---•----------------------------------_--- Date-_------------------ ----- 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 ES 9 REVISED 5-89 2M 8-4E ATLAS