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�rUl� C�rrICE U5 . ...................- ---. ----------_-----..________._--- APPLICATION FOR SANITATION PERMIT Permit No. ..........._......____ --- ---------------------------------------------------- (Complete in Duplicate) --------------- This Permit Expires I 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. JOB ADDRESS AND LOC TION.__� '��__._______. - Owner's Name �.-•----------•------•--------- - ---------------- Phone Address----------_:_^!�- 6k - Contractor's Name-------------- r 2 _ % 6 Phone Installation will serve: Residence [+Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_____ Number of bedrooms _-Z_. Number of baths -1----- Lot size ___ ,z__G�.t—..-..-•-------------------•-_--_-- Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table .Izft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-------.------------I No [Er�_New Construction: Yes JfrNo ❑ FHA/VA: Yes ❑ No TYPE 01= INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T�snk: Distance from nearest well-APA........Distance from foundation__----_ -- Material___________________ No. of compartments-------I--------------Size__�.X5- ---____Liquid depth------S!.-----------------Capacity---- aC! Disposal Field: Distance from nearest i well_T3_!-.------Distance from foundations..r...__.----Distance to nearest lot line_ /....._. Number of lines-----_---#----------------------Length of each line---7-6 -----------------Width of trench.._. .....__--------------- N f Type of filter material----:---.C!5---------.Depth of filter material--- ---------Total length.----5?-_--------------------------- Seepage Pit: Distance to nearest yvell-dd°___r______.___Distance m foundation___t10_f.___.__..Distance to nearest lot line__.�j___._ ❑--_ Number of pits______________________Lining material._____J�� -----Size. Diameter..7.r3.............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)•-- `----It&�_ ........... ------------10i - -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------...--------------- -------------------------------------------------------------------------------------•------------•--------------• --------------------------------------•-------•-----•--•---------------•-••-•------------••----•------- ------•--- •-----------------•------------------------------------•-------------------------•-------------•--------------------------------...-•----------------------------------------•--••----•------------------------ 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 regulati s f the San Joaquin Local Health District. (Signed}..----------•---•----------------------- - ------------ -- --------------------------------(Owner and/or Contractor) By:----------------------------------------- --- ---------------- ---------------------------------------------------(Title)-------------------------------- -------.-...... ........ - (Piot plan, showing size of lot, location of system in relat on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED BY.-- -- ------ --- -------------------------------------------- DATE------- REVIEWEDBY ---- -------•-------------- ------------------------------------------------------- DATE BUILDINGPERMIT ISSUED---_--------------1 -------------------------------------------...------------•------------------.. DATE.--------------------.....-._ Alterations and/or recommend' ti _ ----r---------------.------••___-• -•------- - _- __- ----- "_c _-------- __._ ----- ____-_-•.___--- ------------------•----------------------•----------- FINAL INSPECTION BY:----V- �_ _---•- Date----------b----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 304 West Oak Street 124 Sycamore Strout 205 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS