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FAR OFF,-E :/ .----__ - -.---.-- -fes___-----� 3 APPLICATION FOR SANITATION PERMIT Permit No. .'-.4 --�� --------------------------------------------------------- (Complete in Duplicate) 7 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 and install t work herein described. This application is made in compliance with County Ordinance 549. 1 , JOB ADDRESS AND ATION--:_!_ _ -_�___ o r___ - S._ _.... -•--------•--------•-•------ Owner's Name ±� - Phone�v--- 7`. _ Address------------•----------- •....... l --- --•------------- ------- -------- Contractor's Name. `T `� ..---...-•--...__. Phone_ .._.L . 7-- Installation will serve: Residence J Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ 1 Number of living units: I_.....Number of bedrooms ._:Y Number of baths ---/. Lot size ----�-r7..__�__ _..._.. ... Water Supply: Public system [�IGommuriity system ❑ Private E] Depth to Water Tableft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [I Previous Application Made: {If yes,dote___________________) No ❑ New Construction: Yes C] No FHA/VA: Yes ❑ No E3t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) ti Distance from nearest well.................Distance from foundation------------.-------Material................................................. No. of compartments--------------------------Size------••--•--•••----••--------Liquid depth-----_------------------Capacity............. .....•.. 1. - Disposal Field: Distance from nearest well_.gt_+4_e_.Distance from foundation. _-__ ..Distance to nearest lot line__--- � Number of lines__--___a _ Length of each line__ .3C..'___....__...Width of french____ _��!________._. Type of filter material.__._ __ Depth of filter ma' Tial--------/j0!?._.Total length_________________________ Seepage Pit: Distance to nearest well__fAake------Distance rom foundation__�G?-___.Distance to nearest lot line---------l_O Number of pits...:./______________Lining material__ O_c ___._Size: Diameter-��3 __-_Depth_ ,2,�_ _____________ l Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ElSize: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------D.istance from nearest building-------..........................._-_____. ❑ Distance to nearest lot line-----------------------------------------------------------------------.-.......................___--------------------------------------- ' t Remodeling and/or repairing (describe):___ • . ----•--------------------............... -••--•--.. ---•------•-------•---•......---••---.......--•---------------r'•--'-•-------- -/-/`,yf-,1------Le'-'_------'��-r -F--{-. ...�.}..�. -----.---- .--� r"---/------------------- --------------- 1 ---------------------------------- ---------------•`-------------- ------------------------------------------------ -------•--------•------------------------•----------------------- 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 rules and regulations of the S n Joaquin Local He District. SI ne� ._-_CII�_ -.. _1__ i') ----- f_- 1 Cdl.7l �� Contractor V ++ ) By:.....-••-----••-•----•----------------------#-------------------------------- ... _. . - ------ --------(Title)----------------------------------------.---....---------------- (Plot plan, showing size of lot, location of system in relati to wells, building et ., can be placed on reverse side). t I FOR DEPARTMENT USE ONLY ---- DATE... APPLICATION ACCEPTED BY--- --•- ---T------ - -- ��-�-- -�-='------------------------- -- ----��-r--�---�-- - IkEVIEWEDBY---------------------------------------------- ------------------------------ DATE-----••-----• ----- ----- ------------------•------- lBUILDING PERMIT ISSUED....................... ------- - ............................ DA•TE-----------•------•----------------------------------------- Alterations and/or repo mmendafions•-------- --------------------- ------------------------ -------- •• •----•-•-----•-----------------------•----- -------- ----------------------------- --......------ I ---------------------------------------•------.............. --------------------------------------------------------- ---- 1 o- -----------------------------=---------------------------------------------••-----•-----------------------------------------------------.-..-...._..---- F t i ^ . f I ` --- Date_...-- --- ---------------------------------------------------................INSPECTION BY: jZ, SAN JOAQUIN LOCAL HEALTH DISTRICT t, 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California CO 9 RIVI520 e-95 21A 11-111 ATLAS r