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FOR OFFICE USE: -------------- -------------------------------------- -- APPLICATION Fe)R SANITATION PERMIT Permit No. .l.. _ -----------� _---------------------------------------- (Complete in Duplicate) / - Date Issued -------------------------------------------------------_ i This Permit Expires 1 Year From Date Issued .___.�............. Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herein described. This application is made to comp' ce with County Ordin nce No. 549. � � . �=�., � JOB ADDRESS A -*----•- --- ... - --•- • ..............--.......•.........................-................... l Owner's Name.... ........... ... ---- ----- -- Phone------------------------ --- a j Address---------••-.---•- ........ •--.- ... •.. � - Z ------ ----- ----• •••. -- _ ......................... 12, Contractor's Name--- ,�� _ "f-..-_n1. .. �- ------------- c_1_. .. � Phone.77-:1Ll_ Installation will serve: Residence ❑ Apartment House Commercial C] Trailer Court ❑ Motel ❑ Other C1Number of living units: ..... Number of bedr __ Number of baths... Lot size �, ...__.�� .......................... Water Supply: Public system ❑ Commuriity system ❑ Priva Depth to Water Table .CP.Vft. Character of soil to a depth of 3 feet: Sand.❑ Grevel E] Sandy Loam ❑ Clay Loam [3 Clay E) Adob�Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ N FHA/VA: Yes ❑ No ❑ TYP _ FINSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) P - ~Y Distance compartments from nearest well.. ... .:..... Distance from foundation. _________-______-Material................................................. No .. . Size--------------------------------Liquid depth------------... ..._.._._Ca paci &11 Distance from nearest well__ &_`�_Distance from foundation.. .. Distance to nearest Iine._._�1..��. Number of lines__________ Length of each line____ _C��_'n�____-Width of trench_______________ _ ____...._ Type of filter materiaP4 Depth of filter material------o]--_!?....Total length------------ ............ Seep ge Pit: Distance-to nearest well_-C0--------Distan om f undatio _. nce to nearest lot line__-'_�. \ Number of pits---- -------------Linin material._�____.Size: Diameter___ ell" De th_____ ____ Cesspool: Distance" from nearest well----------------- from foundation--------------------Lining material..................................... '❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------_----------------------------------------Distance from nearest building--------------------------------------.... Distanceto nearest lot line----------------------•-------------------------------------------------•------ ---------------------------------------------------------- Remodeling and/or repairing ( escribe)_________ --------------- ------....--••---••-----------------------------------•- ......--------- ------- ----- ------------- ----- --------------, - ----•---------------------------------- -------------------------------------•---....--=------------------- ... ------•-----------------------------------------------------•--------- ----------........ --------------------- ------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the w r will be done ' accordance with San Joaquin County ordinan a s, and r nd regulations San Joaquin Lo 1 He Di c+. i (Signed).- r .... '2 Contractor) 6 ' ---------- --------- ----•-•------- --------- - (Plot plan, showing size of lit, location of system in relatio wells, buildings, c., c n..be placed on reverse side). FORD TME USE ONLY APPLICATION ACCEPTED Y -�- DATE... -- - —--�--- ----------- REVIEWED BY------------------------------- ------------ ---------------- --------------------- ---------------------------------------- DATE----------------------------------- ----------------------- UILD'fING PERMIT ISSUED-------------------------------------------•-------- --------- DATE----------------------------- ------ �tions and/or recomm n -------I- --------- ....... --------------------------------------------------------------------------------------------•-- ..........C.3 - ---------------------------------------------------------------------------•-•. ----------------------------•-------•--•------------- ----------------------------------------------------------------------..._... ------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------•-•---------------------------- FINAL INSPECTION BDate `L — ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak Strout 124 Sycamore Street 205 West 91h Street Stockton,California Lodir California Manteca,California Tracy,California ES 9 pEVISEb 6.99 2M Z-61 ATLAS