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1-UKUfHU USE: -------- --------------------------------------- f ------------------------ ------------- APPLICATION FOR SANITATION PERMIT Permit No. _._�r:......... --------------------------------------------- (Complete in Duplicate) �//2 / _ ___________________________________________ This Permit Expires 1 Year From Date Issued Date Issued.......;l...' ll..�. L' Application is hereby made to the San Joaquin Local Health District for a permit to constr and install the work hbrein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN N_ Owner's Name........ 4.._. :_ ._ --- ---------------- Phok- .. Address.---------•--•----------•---- - ---------- .. --• --------�---�'-------- ------ ------------------ ------ ------+-----------------------•----....-------•----------------••-----• ! Contractor's Name_ 1+...-- ,/4� ----� ---.....12�!1�..------------------------- Phone-----------------------............ Installation will serve: Residence 0 House Commercial Trailer Court Motel Other Number of living units: ........ Number of bedrooms -------- Number of baths ........ Lot size ............................................................ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table'._._._.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction; Yes ❑ No ❑ FHA/VA. Yes ❑ NO ❑ TYP FINSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . f Distance from nearest well_ Q Distance from foundation_ _.d p f Material ---------------•••••• 11.... No. of com artments.._ __ "i X_36 Size •6��,�---------Liquld eP Capacity .. Disposal 'Field: Distance from nearest well Y2t�1Distannce}rom founds �.. p ,..Dis ante to nearest lot line.____ Number of lines____ ______ _ __ __�_ ___Length of each line_-_C1...../ Vidth of trench._ ....... Type of filter materia _.Depth of filter material---A:r_- -____-Total length....____ __________________ Seepage Pit: Distance to nearest well----------------------Distance 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-_-------.-_-___-__--__________-___-_____. q ❑ Distance to nearest lot line---------------------------------------------------------------•------- --•--••--•-----•-----------------•--•---•---------------------------- Remodeling and/or repairing (describe):------------------------------------ ...................-•----------------------•-----------•----------------......-•••-•---•----•------------------- ------•---•-•-------•----------------------- -----••--------.------------------------------------------------------•---------------------•--------•---•-----------------------•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e I ws, and rul and re ulations of the San Joaquin Local/Healthistrict.g ) — Si ned ........ .. . .. �(,-- ...`(�'�1°"tiRllf er Contractor) By-------------------•------......... ----------------------------------------------------- . -- ---- ....'Title)------------------- ----------------------- ------------ (Plot plan. showing size of lot, location of system in relation to we s uildings, et r can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -------------------------------------- DATE_- DATE___•_ -------------- --- --- -- - ----- - -- ---------- -------------- REVIEWEDBY------------------------------------------------------------------------------- --------------------------------------------- DATE-------•------- BUILDINGPERMIT ISSUED--------------_-----.-...---------------------------------------------------------------------------- DATE. Alterations and/or recommendations:----------------------------------------------------------------------------------------------------------------•--------••-----------•--•-----••--•--------- ------------------------------------------------------------------------------------•--•-----------------------------------------------------------1•----•----- ----------------------------------------------------------•--- Ly FINAL INSPECTION BY: al f• _-0-r--- Date------� 1 -.2------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California rG 9 REVISED a-g9 2M S-fit ATLAS