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------------- FOROFFICE USE: ----------- ------------------------------ -------------- AFrLICATION FOR SANITATION PERM,f Permit No. .I__ ___l,7 _ ------------------------------- --------------------- -- (Complete in Duplicate) 7c --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued __. �,.. ..... Application is hereby made to the San Joaquin Local Health District for a per hitt two c nstruct and install work h eidescribed. This application is made in compliance with County Ordinance No. 549. � Lg, JOB ADDRESS AND LOCATI N.!',jaa•3---4__1_y I._. ------------�A---_`'/---- - ..•t p � .....---_------------------ Owner's Name-- •4..C.�<- ` '- _-— - 3., �L / _ Phone-•--•---••••--•--- O b � Address =----------------------------------------......•........... X Contractor's Name. -------------••--_. Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [X Motel ❑ Other ❑ Number of living units: -c?- Number of bedrooms ________ Number of baths ________ Lot size ----------------9.-. .................... Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ 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--- O_Z._Distance from foundation----'_'-------Material-------- ........ No. of compartments-------- .-------------Size_}_&_X_jQ__X----4Liquid depth-------............Capacity—/ .._. Disposal Field: Distance from nearest well_,S'p___R___Distance from foundation____=....._..Distance to nearest lot Idle----S..f.... Number of lines------------I____________ _____ Length of each line_______ .......Width of trench-------Z------------------------ Type of filter material.__ ..Depth of filter material......./-I-*......Total length........4.0_-12... .................. p�1 Seepage Pit: Distance to nearest well______- ___Distance from foundation------ oundation____- :►_______.Distance to nearest lot line_ [� Number of pits----------,---------Lining material___--Size: Diameter____.--$�.f__. ..._.Depth___4Z.5.................. 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---------- -----------------------------•-----------...-.:.............I........------- --------••------ ------------------ --- Remodeling and/or repairing (describe: ........ r ----- ------•-------------------•-----___-----____--•--------------•------•-----__________---------------__-____ -••--------------•--- ------•---------••----•----------------------.__----------- ----•-•------------•----------------------- ------------------------------------------------------------•-•---•-•-------______---------••--------•--------------•-------••----------••------------------------------------ \4� I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County \w) ordinances, State laws, and rules nd regulations of the San Joaquin Local Health District. �1! (Signed) -------- ----- -----------------------------------------(Owner and/or Contractor) By:-------------- --r+. . ...--.----... ------------'`-----------(Titie)-------------------------------------------- -- - -------------- (Plot plan, showing size of lot, location J system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. - -------------- -- ---•----•- ---- ...------•----------- DATE---- � Imo______ __________ -- REVIEWEDBY------------------------ --------------------------------------------- DATE-------•---------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------- ----------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:-------------- ......... --•- ---•----_---•-----•-•------------------------------ -----------------------------------------------_.------------------------------------------------------------- C/- •------------___ -- ----•---•••••----- -------- --- •--------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------- FINAL INSPECTION BY:../ --------------------------- Date----1f�"� ----- 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 8.89 ZM 5-E1 ATLAS