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FOR OFFICE SE: 3 .... � ----------------------------3 2-7------__----_�6. APPLICATION FOR SANITATION PERMIT Permit No. ..�..�� - --------------------------_- ------- ----------- -- (Complete in Duplicate) -.--- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for peirmit-to construct and install-the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN LOCATION.---'7- --- . Owner's Name 'Xn='A,....... Phone-----------------•---.................................... Address z >- ---------------------- - ------------------------ --------------------------- = =------------=--•---••- •----•------......................... Contractor's Name------ ••-••----- -----------------------------------------------------...__...------..._...-----...._........---... Phone................................... Installation will serve: Residence e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---J___ Number of bedrooms 3___ Number of baths -_/_____ Lot size _.__L�______________________________•• a- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table 41 ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: {If yes,date--------------------) No New Construction: Yes �o FHA/VA: Yes ❑ No E;�- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . t f � Septic Yank: Distance from nearest well� ---------Distance from foundation__]a_____________Material____L`:e_..--_......_.......:.......•.......__ 2 x�5 x g'Uc No. of compartments ----Size--•-3:-••-•- r --•--Liquid depth..--- . ------------Capacity-- r , • i Disposal Field: Distance from nearest.weli_-t--5-_0_._____Distance from foundation./O..r_........Distance to nearest lot line__.__._.�------ Number --_-- Number of lines-----------2 Length of each line____; d_��__-____..Width of trench__�3 .........._ - - Type of filter material._.__ bC�_-____Depth of filter materlal____�� _______._Total length--------A0�__ ___________________ r r 4 Seepage Pit: Distance to near est j'ell__�oQ..............Distance from fo ndation_��______-____.Distance to nearest lot line__.`_ ...._.._ (`1 ®� Number of pits----_.-:—--------Lining material-------��-,.Size: Diameter----.-33- Depth----.-z------------------ Cesspool: --•---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___-.---•___-__-____-_____.________-___._. ❑ Distance to nearest lot line---------------------------------- -------------------------------------------•-------------------•----------•--------------------------------- Remodeling and/or repairing (describe):_ _-________________________________ _____ _ ________ :: ------•-------------------- --- ----------------•--•••---------------------•-•------------•-----------•-----------••-•------•---•---•--•---•---------..------------------••---------------------------------•--- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ruleZ� n gul ions of the San Joaquin Local Health District. (Signed)--------------------------------- • -----...-•----:-------------------------•-----------------------------------------------(Owner and/or Contractor) Y•---------------------------- ----------------------------- {Title)---......:.----------- ----•--------••- .-- (Plot plan, showing size of let, locaioof syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED ----------------------- DATE_' .-�-� - _._ ,_- 6- ms' s REVIEWED BY------------------ --- ; = -- - ----=-------------------- DATE---------=.-----------------------------: ---- - DATE_:._. •._.. BUILDING PERMIT ISSUED---------------------- `-----------= �,`.; =-_--•-----= ._...--------• AlterAtion and/or recommendation;: = -`. -- x_._ ................:..: ...••--•-- ----_...-•--------•--------------••----•------------- •---- .:................. •---- Z`l� -------------------------------- -- ----- --------- -•--------•--------------------------------------- ----- ..........................:..................................... FINAL INSPECTIONBY%-- ------ ------- ------------------------------ Date --Y/ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Weft Oak Strout 124 SycamoreStreet205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California rS 9 REVISED a-S9 2M 8.61 ATLAS - - ,