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FOR OFFIC USE: APPLICATION FOR SANITATION PERMIT Permit No. ........... ..: ...... ---`----__________________ (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 a d install the work herein described. This application is made in compliance with County Ordinance No. 549. a --------------------- h JOB ADDRESS AND LOCATION.4P-:____-• ------------•-------- ---- Owner s Name a'm....�`F` Lid --_---------------------------------------------------- ---------------------------------------•--- Phone-----------•------_----------------- - ---------------------------------•---------•------------•--•---------- i Address-------1.I�.Q.rz�__��.__.--_ - - -- Contractor's Nam --•------ ---- ----- Phone..--------_-------------........ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ /' �/ k Number of living units: ---j--- Number of bedrooms _- -_ Number of baths .2.._- Lot size ....�_._ ____. Water Supply: Public system ❑ Community system ❑ Private [36epth To Water Table _.0 ft. ,r Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam El Clay Loam EI Clay [3 Adobe�ardpan C1 Previous Application Made: (If yes,date--------------------) No [ New Construction: Yes M--No ❑ FHA/VA: Yes [s --"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feat.) Septic Tank: Distance from nearest well_ _______Distance from foundation_-.-�� ---.----.Material_._- ' ° ' ---•-----Zep_--• No. of compartments' ------,__------Si5+�( -tC_!_ -.--------Liquid deph----IW---------------- to nearest lot li s�� pispas�l Field: Distance from nearest wel__ -�__--------Distance from found ____ation__f _---------_...Distance y ...----• ( Number of lines--..____ -----------------•-Length of each line---17 of trench._ ----------- .------------ Type of filter material f2flA-__-------Depth of filter material_.-T --------------.Total length---/s P-------.------------••-•---- Seepage Pit: Distance to nearest well__1aQ'1----------Distance from foundation-Aa/..........Distance to nearest lot -------•- - ----Size: Diameter---- �� 3--------..Depth---------------------------- --- Number of pits-------�--------Lining material-_. a 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------------------------------------------ F1Distance to nearest lot line-------------------------------------------------------- ------•----------•--------••------•--------•---------------•------------------- I Remodeling and/or repairing (describe)--------------------------------------------------------------- -•----•--------------------•------•-------•--------...-•-----•--••---•-_-------•---•- i --•----- :.. 1. -----•---------------------------------------------------------------------------------------------------------------------------------------------- --------- ---•-----•--------•---------•---•-----------••-------•-----------------•----------------- ------------------------------------...-----•-----••---------------•----•---•---------•------------------- I hereby certify that I have prepared this applica ion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulati of a Sa Joaquin Local Health District. ' (Signed) ------------------------------- -------------------------•- ------(Owner and/or Contractor) Title--------------------------------------------- -------------- By:------------------ -------- - { (Plot plan, showing size of lot, loco Ian of system in relation to walls, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- --- --------------------------------- - --- DATE_J_�L 7-7 ` REVIEWED BY--_----------------- ---- DATE BUILDINGPERMIT ISSUED---------------------------------- ----•- ----------------------------•---------------- DATE--------------------•--------------•------------------------ Alterations and/or recommendations:.._-� 0A......... ra. _ .3__ ---------••------•-•_-•------------------------------------------------- ---------------................................... ---•---------•---------------------- ----------- ------- -------- --------------- ------------------------------------------------•----------------------------------•----•------------------•------------ ----•------------------••----------------- .............................. - �__ ' -+ FINAL INSPECTION BY: G.� -�7Dafie_. �- "� ...-.- / SAN OAQUMI- LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California F, Manteca,California Tracy,California £S 9 REVISED B-59 2M 5-62 ATLAS