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FOR OFFIC USE: -06 w a.� APPLICATION FOR SANITATION PERMIT Permit No. ----------- r ------------------------------ '(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 a permit to construct and install the work herein described. This application is made in compliance with County{Ordinance No. 549. h JOB ADDRESS AND,��CATION---- `S U �t------ --------- e DC7 Owner's Name-------/"----•-• •-- •----- .�./��'_-•��.i---•---------•---...-----------•--...-- -----------......---••------•--•-----•----- Phone _�Q..�.-•---.. Address........--•----•--- --------•-•--- Contractor's f - .. SCC ---------- Phone&.z --•---.z Installation will serve: Residence artment House❑ Commercial ❑ [��prailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: _/-_ N mbar of bedrooms ._ _. Number of baths/---- Lot size ---p�)_ ----..�,....,��.�_._-_---.- Water Supply: Public system Community system I_-] Private I-] Depthto Water Table 6'j ft. Character of soil to.a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e---riardparl ❑ Previous Application Made: (If yes,dote--------------------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONSk'tl ; (No septic tank or cesspool permitted if p blit s or is available within 200 feet.) SPtiTank: Distance from nearest waH_)` .__-_ .Distanto faug�tjyn..1-D__f______.Materi I----------------------- ---No. of compartments-.n� ____ e �Siz 6_ .Liquid de�th-_ S- ---------Capacity_-_ D_---... to nearest lot line-_-_:!._Q: Dis os I Field: Distance from nearest well-. ------ ---.Distance from foundation_- _ _ Number of lines------4-- --------- -Length of each line----- f__-��`_----Width of trench.-_CNXr--��_..r___.... Type of filter material k. -_-_Depth of filter material_ -�_ ----Total length-------------------!j ....... p Seeps a Pit: Distance to nearest well--11-t- -- --___Distanct from foundation_- ®.r--.:Distance to nearest lot line----_-_C Number of pits.... _ Lining material_. e_---- Size: Diameter----0-2��_ - -,De th_--.i cor............... esspool: Distance from nearest well.................Distance fr foundation------------------- material__-------_--_------------__---__.---. ❑ Size: Diameter Depth- --------L------------------ Liquid Capacity...------ gals. Privy: Distance from nearest well----------------------------------------------- from nearest building.......................,.................. ❑ Distance to nearest lot line-----------------------------------------"-----•------------•-- ................ -•---------............-_---------------------- odeling and/or repairing (describe):---- -- _____________________ Rem, � •------ -----------•---------------------------------=----•--------•-••------- -------•----------•-------------- ----------- --------------------- - --------------:�f----------------------- --••---------------•--••----------------------•-------•--------------------------------•------------ -- -------•--•----•--•------- '------••--•---•-•--—-•-•------ --------•------------m.............----•---• PP----•----------------------------•---------------•-••-------•---------------•--------------_------------=_-----------•-------•---- I.herebycertifythat I have prepared this application and that the work will be done in accordance with San Joaquin County ordin ces, State I and rules and re lations San Jo ' Local Health District. _.(Signed) �g --�----------------------------------------- _ r Contractor) By:...................................................................... ----- Title ----------------------------- ---- ----------------- -- ---- ----------- (Title) (Plot plan, showing size of lot, location of system in tion to wells, bu' ings, a ., can be placed an reverse side). FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY_ ! s"``� DATE-- -A---�'-l�I---�l-- 6'2`' --------------- - REVIEWED BY----------------------•------------------------------------------------------------------------------------------------ -- DATE-------------------------•--------- ---------------------- BUILDING PERMIT ISSUED-------------- ------ - DATE-------------- ------------------------------------------ 71 04- Alterations and/or recammendations:--..... ! � .. ... ................ ..../n - ' Y ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Z ------------------------------------------------------------------------------------------------------------------------•-------------------__-----------------------------------------'--------------------------------------- Ae FINAL INSPECTION BY ---- •-------•- Date-/ 1=-- ` ---------------- ]ll SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strut 124 Sycamore Street 205 West 91h Strut Stockton,California Lodi,California Manteca,California Tracy,California Eb 9 REVI BED B-59 PM 5.61 ATLAS - 1