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FOR OFFICE USE: --------------------------------------------------------- --- -- -- ------- ------------------ t t---__• APPLICATION FOR SANITATION PERMIT Permit No. ... ...... f.1.__ . ---------------- -------------------------- (Complete in Duplicate) r -------------- This Permit Expires 1 Year From Date Issued, Date Issued .._ /�7_ v Application is hereby made to the San Joaquin Local Health District for a permitnstruc and install the/work h r This applica ion,is made.,in-compliance with County Ordinance No. 549. � �J _ JOB ADDRESS AND LOC ATION- --�-_-�' _1 Owner's Nam _. _ 1� --4G_ 1 --------------------------------------- Phone-----•----------------------....... ------------------ Address........--•-------------- ----•-. Contractor's Name. --------------- Phone ------- -------- ---- - Installation will serve: Residence E] Apartmen House ❑ Commercial Trailer Cort ❑ Motel ❑ Other ❑ Number of living units: ........ Number of bedrooms -------- Number of baths ........ Lot size --------------1�_r..... --------I...... Water Supply: Public system ❑ Community system ❑ Private [2 Depth to Water Table ..._... ft. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date____________________) No ❑ , ;New Construction:4 Yes.Qe No ❑ FHA/VA: Yes ❑ No ❑ T TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S� tic Tank: Distance from nearest well----o�d_--_Distance from foundation_____ No. of compartments-•-• ----------------Sizer-- a ®-X-:•�.---Liquid depth___.�_---------------Capacity.r 0 ....A..... ---- -----------_Length of each line_•__•-••- -- _ I Number of lines.....______ - ��„ -�•--------Distance to nearest lot line...,_.__..__ �• Disp I Field: Distance from nearest well... Distance`from foundation._.._ 9 •----Width of french..._.'(------------- -•----... �i f , Type of filter material-_. ____ _ Depth of-filter matenal----- ______.__Total length_______/`.5 ..... ...... Seepage Pit: Distance to nearest well----------------------Distance from foundation___.................Distance to nearest lot line__..___-......... ❑ Number of pits--•-------------------Lining material.....----h-------------Size: Diameter------------•-----..__..Depth---------------------------_-_--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material._.-------------------------------- � i { r ❑ Size: Diameter------------------------- `-- Depth___ -----------------------Liquid Capacity------------------...:..- 9als. Privy: Distance from nearest welly____________._.________ _ ---------Distance from nearest building_________________________________________ ❑ Distance to nearest lot line----------------------------------------------------- l ' RIrl (describe):-----------------------------------------------`----------------------••------•-----------•-••-• ..........-------------------_.......................... ,__________________________________________________________________________________________________•-____--_.--_.--_S________________________-__..___«.._.»._.______..._._______-_-_____---_-----.--_______________-_.___1 -----------------------------------------------------------_-------------------------------------------------------------.-------------------------------------------------------------------------------------------------- --•---.crew ! — I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, .S ate laws, and ales and regulations of-the San•Joequin Local Health District. ti ;, (Signedsem_-- Et1__ . • ' 9 }.. ----- - ------------- r Contractor) a --------------(Title)------------------------------------------------ ----------� N (Plot plan, showing size of lot, location of system in relatign to wells, building's, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- _ ------------------------------------------------------- DATES r Z' - l REVIEWEDBY--------------------------------------------- ------------------------------------ •---------------------------------------- DATE----------------....--------•--••--------------------' BUILDINGPERMIT ISSUED--------------------.-----------------------.--------------•----------------------------------------- DATE--------------------•-----•-------------------------------- Alterations and/or recommendations----------------------------------._ 1 ------- -1-------------------------------------------------••--•------•----------------------------------------------------------------------------------------------------------..._......------•----------------------------------- FINAL INSPECTION BY ____________________ Date__ ./ -�v SAN JOAQUIN 16CAL HEALTH DISTRICT., 130 South American Street 300 Wast Oak Street Com' 124 Sycamore Street i 205 West 9th Street { Stockton,California Lod],California S Manteca,California Tracy,California ES 9 R%VIS90 8.89 8M 8.61 ATLAS H i