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------------- --- ----- ---- � ' APPLICATION _FOR SANITATION PERMIT Permit No. �-- [Complete in buplicatel 69-� ------- --- This Permit Expires 1 Year From Date Issued Date Issued _ /��. Application is hereby made to the San Joaquin Local'He h District for a permit to construct-and install'the work,herein described. This application is made in compliant with County O i nce Noi 549. J46 ADDRESSAL4OdC_ ATIO - ~"---- ---•-- - --Owner's Name.- _____•_""__" _ - --• .. _...._...-4---- ................... Phone _A-A6o.'1.---•. Address".--•-------------•--`-�-c�� G �. .. Contractor's Name------- �� 4 - - Phone . .... f f Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Tra'I�r} ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms."_"_-_.Number of bath Lot size -."-- Water Supply: Public system --- ----••-----•-----•---------•--•-•-----...._ Y Community system ❑ Private [] Depth to Wafer Table- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayAdobe j Previous Application Made: (If yes,date-""".__"."-"-.-----) o N ❑ New Construction: Yes No ❑ ardpan ❑ ! ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ' ubiic sewer is available within 200 feet.) Septic Tank: Distance from nearest we[ Dis}ante fro fau�dation_ 1�- ------.. Liquid de th"" "4. r No. of compartments y � P Slze. � 1� 9 R -------- Capaci tY �Q. Disposal field: Distance from nearest wel .Distance from foundation. r --� _/Q__""...----Distance to nearest lot line-....._...a .-. - Number of lines"...__ Length of each line----- _"� ------Width of trench.�.�//��•-•___ � Type of filter .materialf - Depth of filter material-_.-Zx-------•--Total length-------_------ _••_" ....... Seepage t: Distance to nearest well" i �''.---Distanc m f ndation".j140"f_____.Distance to nearest lot line....*-,S .... Number of its-_ . AF P - --------"--Lining material / .�--Size: AF. Dept Cesspool: Distance from nearest well-----------------Distance from foundation.--_.---------.--".Lining material............... Size: Diameter. '!------------------------------- _"...._ Liquid Capacity----------------------------gals. Privy: Distance from nearest.well-------------------------------------------------Distance from nearest building Distance to nearest lot line Remodeling and/or repairing (describ�):"- ------------------------------------------ir----- - --...-•-----•------•-1 •---•--•�•----••---• ----..-.-------------- ---•---- - �. .. ---- -- .- -- ---------A-------IV ----.-.-.!.-. -• •---.-.--•• --- ----------------------------------- ------------ -- -- --_- -- -•-•----------- t------------- -- ------------------------ ------J-,---------------- ----- - --•--------•----•-------------•--•-------------...-------•--------------•---•--•-------•------------•••---•------•-----••---------------- I hereb y that I have prepared this application and that the work will.be done in accordancewith San Joaquin County ordinances, to ws, and ru s and re a+ions ol +he San Joaquin Local Health District. (Signed)-_-_--- •- k (Owner and/or Contractor) {Plot plan. showing size of lot, location of s tem in relation to we , buildings, eft., cart be placed on reverse side}, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-" """"_ _ _-""""_" EVIEWED BY " - DATE------ - ---------: Jf/ --•---------- -- - ------- DATE........................................................... $UILDING PERMIT ISSUED..-------_-.•-- _ I ---------- i n pd/or recommendations:----•--- f4TE.. 4 ------------------•----------------•----------- ------------ -------------"---••---------•------••---•--------•----------- ---•-------------- --------------------------------•-----------------••---- ----------------------------------r FINAL INSPECTION BY:.._". J ` - Date"" SAN JOAQUIN LOCAL HEALTH DISTRICT t� 130 South Amu American Street 300 West Oak Street 124 Sycamore Street ;205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California ES 9 REVISED H-99 2M 6-61 ATLAR