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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT Permit No. ............. ...� ---------------------------------------- --- ------ (Complete in Duplicate) / 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 the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----- Aic_ �ic`s�►------------------------------------------------------------------------------------ _--_-----_------------ Owner's Name._ iC► -------------•-----•----------••------------------•------ Phone. Address.- -•--------- . ------------------------------* ::Z Contractor's Name ---��---------------------------------------------••---•.... Phone. i Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J_- Number of bedrooms ---Z Number of baths .---1_- Lot size ...'4-:�-d ................... Water Supply: Public system ,,,--community system [3Private ❑ Depth to Water Table .6yft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe tr'�Hardpan ❑ Previous Application Made: (if yes,date-------------------_) No New Construction: Yes W---No ❑ FHA/VA: Yes []-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septfc Tank: Distance from nearest well_-_'-Distance from foundation__ ------------Material.....-..�_______________________•---.-.-.-Q.-._. •----. No, of compartments-----2 _____________Size.......... Liquid depthi' Capacity Disposal Field: Distance from nearest well_____ ________Distance from foundation..AP-------------Distance to nearest lot line.4_-r......_ Number of lines------------------_t___----------Length of each line-------- _ ---Width of trench.___.......,. ----______.___ Type of filter material.... L -----Depth of filter material---Ir---- ______.Total length....:..90..`________________•--..-_. Seepage It: Distance to nearest well----------------------Distance fou ation....Ag.?7 ..Distance to nearest lot line._._._'r�'.___._. ' Number of pits--•--.1---------------Lining material______-- Size: Diameter-------3�- -___.Depth----••......zi:r---------- Cesspool: Distance from nearest well_________________Distance from foundation_------------------ Lining material--------------............------.__._ X ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------..Liquid Capacity------------_-------------gals. Privy: Distance from nearest well-----------------------.-------------------------Distance from nearest building------------------------------------------ F1Distance to nearest lot line-------------------------------------------------------------------_--•-_---...._----------------------•-•------•.------•-------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------•------------ ....................... --------------•------------•---------------------•--•-• --------------•------------------------------------ ------------------------------------------------------.------------------------------------------------------- N ------ ------------------------------------------------------------------------------------------------------------------------------------------------...-.---------••----•----...----------•----------------•- I hereby certify that I have prepared this application and th ork will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San o ui ocal Health District. (Signed)----------------------------------------------------------- -------------- ------------------------------------------(Owner and/or Contractor) By:------------------------•--•-••............................. --•-- ---- -- ---- ----- • - - -------------------(Title)----------------• - --------• .•---......--. --------------- (Plot plan, showing size of lot, location of syst in r n t wells, build' gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- -------------------------------------------•-----...... DATE--3-- 3 REVIEWED BY ---------------------------••-•-•---•------- DAT --- BUILDINGPERMIT ISSUED-------------------------------------------------------------------_-------------------•--- ..... DATE------------------------------------------------------------- Alterations and/or recom endations:____ r_____________________________ _' .. ._1..,r,> _ " w_ �'.+J �__.. ................------- Al //// ■ A ..........____......_--------------------------------------------------------------------------------___________________r_-------------------.........----------------------------------------------------------------- FINAL INSPECTION BY:.....:./ fDate-...._-'"7` ~ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wool Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 HEVIs Ed 8-99 2M 5-61 ATLAS