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FOR OFFICE. USE: ------------------------------------------------------ +. ______________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No—,/�r��3 ---------- ----------- --------- ------ - -- --- (Complete in Duplica+e) Date Issued __---------------------------------------------- This Permit Expires 1 Year From Date Issued_ Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. hip�lican iiad7` compliance with County Or(dinanc� No. 549. ��, 2sd afapr JOB ADDRESS AND LOCATION_..... _.... -'-------('�'----------- -- --------------------------------------------------------------...........I---------------------- Owner's Name..---- I&i elf, ------ ----------------------------------- ---- Phone----------------- Address , �'�"p•1--- -1-�-•--•------------- - ----- - Contractor's Name----------- -----------------••---•..... ----------- Phone---......... ._.... Al Installation will serve: Residence ❑ Apartment House ❑ /Commercial L] Trailer Court ❑ Motel ❑ Other ED . Number of living units: --__ Number of bedrooms _Y-- Number of baths ___I___ Lot size ----------- . Water Supply: Public system ❑ Community system ❑ Private" Depth To Water Table f�"ft.Yj Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe t�r Hardpan ❑ `4 Previous Application Made: (If yes,date---------------.----) No New Construction: Yes,[ No E] FHA/VA: Yes [:] No� '�•.1 TYPE OF INSTALLATION AND SPECIFICATIONS: J� ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___ c6J+.. ------- Dizstant from foundation_1_d�.e........ ___________ No. of compartments---------_--�-.._._Sie..'x8 X-6___•__.-Li uid th----- ✓------Ca acitY•Y .... Disposal ••-----••--- Field: Distance from nearest well.__7a_......Distance from founda ion____� __. ..Distance to nearest lotline___ _._.� Number of lines___________ _ '�o '�D cf �_-_-- _ _Length of each line_---�------------- .Width of trench...-.�!1.�:.-•-------------••- Type of filter materral._rs_____ ____V.____CDepth of filter material_______ _ ___.___Total length____.e�s __.______._________________..__ Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line-----........ .... ❑ Number of pits.----------•----------Lining material--------•--------------Size: Diameter-----------------------Depth--------------------------------- 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 --- - --•-------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an�rules and regulations of the San Joaquin Local Health District. (Signed)'---- -- -------- -------------------------•---------------------------------------(Owner and/or Contractor) By:-------------------------- --------------------------------------------------------- -----------.-------•-•-- -------------------(Title)---------- ---------------------------------------------- ------ (Plot plan, showing size of lot, location-of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------- ------ ----------- ---- •.............-•-•-------......-_...... DATE....-----• •----•--•----- -------------.----------------- REVIEWED BY-------------------•--------••--------- •-.------------- --- DATE---516....-=-•/�--- --•----------------- BUILDING PERMIT ISSUED-----•-------------------- --- - ;/e- -------------------------------------- DATE------------------------------------------------------------- Alterafions and/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------•--------------------------------------------------------------------------------------------------------------------------------•._...-•--•---------•--------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------•--.....---••---•--•--------•-•-------------------------------------- .................................. -------- - S-- //- � 3 FINAL INSPECTION BY:-- ------ ��---------- Date------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED B-59 2M 5-62 ATLAS